Prevalence and prognostic value of cirrhotic cardiomyopathy as defined according to the proposed new classification

Abstract

Aim of the study: Prevalence and prognostic relevance of cirrhotic cardiomyopathy (CCM), as defined according to the new core criteria proposed in 2019, are still unknown. We investigated this relevant issue in a large cohort of cirrhotic patients. Material and methods: We retrospectively interrogated a data set of 162 collected cirrhotic patients followed up for at least 6 years, who underwent standard Doppler echocardiography and were compared with 46 healthy subjects. Left ventricular (LV) geometry, systo-diastolic function, global longitudinal strain and the main hemodynamic parameters were assessed according to current guidelines. Systolic dysfunction was diagnosed if LV ejection fraction (LVEF) ≤ 50% and/or global longitudinal strain (GLS) < 18% or > 22%. Results: Adequate echocardiographic images permitting speckle tracking analysis were available in 83 patients. No patient presented LVEF ≤ 50%, GLS < 18% or > 22% was evident in 25%, advanced diastolic dysfunction was evident in 10%. Overall the prevalence of CCM was 29%. Patients with and without CCM presented similar clinical, biochemical, hemodynamic and echocardiographic features at baseline and similar incidence of death or type 1 hepatorenal syndrome at follow-up. Conclusions: According to the new criteria CCM is detected in 29%, mainly due to altered GLS at rest, but without prognostic relevance and therefore useless for the clinical management of cirrhotic patients. We propose to modify the criteria by removing the LVEF assessment and adding also a stress test assessing the cardiac contractile reserve to distinguish patients with a blunted cardiac response, which could present a worst prognosis.

HFA-PEFF score as an independent predictor of 2-year mortality in liver cirrhosis patients

“…On top of those findings, a recently published study by Cesari et al ., investigated the diagnostic and prognostic role of the new proposed diagnostic criteria of CCM [4,26]. According to their findings, diagnosis of CCM based on the proposed diagnostic criteria of CCM was not related to survival.…”

Pathogenic Mechanisms Underlying Cirrhotic Cardiomyopathy

“…Some studies have used the new criteria to calculate the prevalence of CCM. Unfortunately, all the studies used a global longitudinal strain (GLS) score <18% or >22% as abnormal criteria (Cesari et al, 2021;Razpotnik et al, 2021;Kaur and Premkumar, 2022). This is because the original publication (Izzy et al, 2020) contained an error in the GLS criteria: it should have only been <18%, and not also >22%.…”

Cirrhotic cardiomyopathy: Toward an optimized definition

“…This implies that there is still room for improvement and modification of the diagnostic criteria for the purpose of a better prognostic relevance. [ 6 ] Nevertheless, the article by Spann et al represents an important step forward in our attempts to define those patients with cirrhosis with a cardiac dysfunction who may suffer an increased risk of MACE. Although the 2020 criteria may not be perfect, they include less load‐dependent measures of diastolic dysfunction.…”

“…For example, the prevalence according to the 2005 criteria may be as high as 50%, whereas it averages 28%–35% when applying the 2020 criteria. [ 5,6 ]…”

“…For example, the prevalence according to the 2005 criteria may be as high as 50%, whereas it averages 28%-35% when applying the 2020 criteria. [5,6] In this issue of Liver Transplantation, Spann et al have approached this question by comparing • LVEF ≤50%…”