Left ventricular systolic function is associated with sympathetic nervous activity and markers of inflammation in cirrhosis

Abstract

LV systolic function is enhanced in cirrhosis due to augmented adrenergic tone and modulated by treatment with beta-blockers; acute afterload stress induces a deeper impairment of systolic function in patients with more advanced degrees of vasodilatation and inflammation; these changes in LV function related to cirrhosis can be assessed using robust echocardiographic methods. (Hepatology 2017;65:2019-2030).

Increased myocardial contractility identifies patients with decompensated cirrhosis requiring liver transplantation

“…This could also be substantiated by the data provided by other groups . An enhancement of sympathetic nervous activity resulting in an augmented systolic function might also play a role in the pathophysiology of the increase of myocardial contractility as recently shown . Especially in Child‐Pugh C patients, STE parameters were independent predictors of transplant‐free survival and time to transplantation.…”

Cardiac function, A key component in evaluation for liver transplant

“…However, using the tools noted above, it has been recently demonstrated that systolic function is not depressed but actually enhanced in patients with cirrhosis and directly correlates with the severity of the liver disease (Child‐Pugh and Model for End‐Stage Liver Disease scores) . This has been attributed to a direct inotropic effect induced by the activation of the sympathetic nervous system (SNS) in cirrhosis . The enhanced GLS in patients with end‐stage liver disease described by Jansen et al further corroborates this finding, although the potential confusion caused by the afterload‐dependence of myocardial strain should also be taken into account.…”

“…Albeit to a lesser extent than ejection fraction (EF), previous experimental and clinical validation studies have shown that the index used global longitudinal strain (GLS), is also dependent on afterload, and may have limited sensitivity to account for myocardial contractility. Recently, we have demonstrated that other echocardiographic indices based on the analysis of intraventricular flow (ie, intraventricular pressure gradients) can help resolve these limitations, particularly in advanced cirrhosis …”

“…Classically, high values of EF observed in patients with cirrhosis had been related to the existence of a very low afterload in the presence of normal or even “latently” impaired systolic function (ie, cirrhotic cardiomyopathy). However, using the tools noted above, it has been recently demonstrated that systolic function is not depressed but actually enhanced in patients with cirrhosis and directly correlates with the severity of the liver disease (Child‐Pugh and Model for End‐Stage Liver Disease scores) . This has been attributed to a direct inotropic effect induced by the activation of the sympathetic nervous system (SNS) in cirrhosis .…”

“…In addition, the large overlap of GLS values between Child‐Pugh categories and the lack of differences between Child B and C categories in the validation cohort may be related to its limited inotropic sensitivity. Moreover, the study needs to be placed in the perspective of previous studies that have failed to find a correlation between myocardial deformation indices (as used by the authors) with different degrees of Child‐Pugh score or clinical decompensation …”