Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View

Abstract

Background: Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. Methods: This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. Results: RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. Conclusions: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.

Right ventricular dysfunction in cirrhosis: A speckle-tracking echocardiography study

“…In our study, using speckle-tracking strain analysis, we showed that RV-GLS measurements were significantly lower in patients with cirrhosis than in controls. Our results are similar to those of other studies that found reduced RV strain in patients with cirrhosis [19,21]. In addition, in our study, RV-GLS measurements were lower in patients with ascites than in patients without.…”

“…RV function is more difficult to evaluate than LV function. The fine changes in the systolic and the diastolic functions of the heart, which can be seen in cirrhotic patients, may not be detected with the conventional transthoracic echocardiography [19]. Novel echocardiographic techniques can improve the quantitative assessment of RV function.…”

Evaluation of subclinical ventricular systolic dysfunction assessed using global longitudinal strain in liver cirrhosis: A systematic review, meta-analysis, and meta-regression

“…There were four cross-sectional [ 11 , 45 , 46 , 48 ], five case-control [ 10 , 49 – 52 ], five prospective cohort studies [ 36 , 54 , 56 – 58 ] providing results only for the left ventricle. Meanwhile, one cross-sectional study [ 47 ] providing result only for the right ventricle. There were two case-control studies [ 10 , 52 ] in which evaluations were performed using CMR and others using 2D-STE.…”

“…There were two case-control studies [ 10 , 52 ] in which evaluations were performed using CMR and others using 2D-STE. Five cross-sectional [ 11 , 15 , 45 , 47 , 48 ], three case-control [ 50 , 51 , 53 ], and five prospective cohort studies [ 14 , 36 , 54 , 57 – 59 ] used the EchoPAC system; one cross-sectional [ 46 ], one case-control [ 49 ], and one prospective cohort study [ 55 ] used Velocity Vector Imaging and one prospective cohort study [ 56 ] used the QLAB system for 2D-STE evaluation. The etiology of cirrhosis varied; the most common etiologies were hepatitis B and C viruses [ 10 , 14 , 15 , 36 , 45 , 46 , 48 , 49 , 52 – 54 , 56 – 59 ].…”

The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients

“…Zhang et al, found that in alcoholic cirrhotic patients RA maximal area and RA volume index were higher and both RA and RV functions deteriorated. Unfortunately, in that study the influence of alcohol on right heart functions could not be excluded [32]. Patients with increased RA pressure before and after transjugular intrahepatic portosystemic shunt (TIPS) had approximately twice the mortality of those with normal RA pressure [33].…”