Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium

Abstract

BackgroundThe new criteria of Cirrhotic Cardiomyopathy Consortium (CCC) propose the use of left ventricular global longitudinal strain (LV‐GLS) for evaluation of systolic function in patients with cirrhosis. The aim of this study was to evaluate LV‐GLS and left atrial (LA) strain in association with the severity of liver disease and to assess the characteristics of cirrhotic cardiomyopathy (CCM).MethodsOne hundred and thirty‐five cirrhotic patients were included. Standard echocardiography and speckle tracking echocardiography (2D‐STE) were performed, and dual X‐ray absorptiometry was used to quantify the total and regional fat mass. CCM was defined, based on the criteria of CCC, as having advanced diastolic dysfunction, left ventricular ejection fraction ≤50% and/or a GLS <18%.ResultsLV‐GLS lower or higher than the absolute mean value (22.7%) was not associated with mortality (logrank, p = 0.96). LV‐GLS was higher in patients with Model for end stage liver disease (MELD) score ≥15 compared to MELD score <15 (p = 0.004). MELD score was the only factor independently associated with systolic function (LV‐GLS <22.7% vs. ≥22.7%) (Odds Ratio:1.141, p = 0.032). Patients with CCM (n = 11) had higher values of estimated volume of visceral adipose tissue compared with patients without CCM (median: 735 vs. 641 cm3, p = 0.039). On multivariable Cox regression analysis, MELD score [Hazard Ratio (HR):1.26, p < 0.001] and LA reservoir strain (HR:0.96, p = 0.017) were the only factors independently associated with the outcome.ConclusionIn our study, absolute LV‐GLS was higher in more severe liver disease, and LA reservoir strain was significantly associated with the outcome in patients with end‐stage liver disease.

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy

“…Skouloudi et al demonstrated that patients with MELD scores above 15 had significantly higher absolute GLS compared to patients with MELD scores below 15. This finding was also evident in the multivariate analysis, where the MELD score was the only factor associated with GLS [55]. Mechelink et al found that patients with decompensated LC had increased absolute GLS values compared to patients with compensated LC without portal hypertension.…”

“…Skouloudi et al did not find an association between LA strain and MELD score. However, in the prospective study, they presented that patients with reduced LA reservoir strain had a worse prognosis in the multivariate model, which also included MELD (HR 0.96, 95%CI 0.93-0.99; p = 0.017) [55]. These initial findings are consistent in that LA strain does not differ so profoundly between patients and controls, as the left atrial dimension indicates.…”

“…In contrast to those findings, Rimbas et al did not find significant differences in RV global longitudinal strain between patients and controls [38]. Skouloudi et al presented that RV-free wall strain did not differ between patients with MELD lower or above 15 and that it was not associated with a worse prognosis [55].…”

“…Dimitroglou et al found that abnormal GLS values (either <18 or >22) were evident in 48.5% of patients, with none of them having an LVEF value below 50% [63]. Skouloudi et al, on the other hand, calculated the prevalence of CCM based on the presence of GLS <18 and found that only 3.7% of patients satisfied the systolic criterion [55]. Interestingly, all aforementioned studies reported that CCM diagnosis was not associated with the disease prognosis.…”

Update on cirrhotic cardiomyopathy: from etiopathogenesis to treatment

“…Retrospective data suggest that diastolic dysfunction has a prevalence of 10.5-33.3% in patients with cirrhosis [ 20 , 46 ]. Diastolic dysfunction is characterized by a stiff ventricle with impaired relaxation and filling.…”