Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease

Abstract

Background: Cardiac function can be influenced by liver cirrhosis and should be thoroughly evaluated before liver transplantation. We investigated left ventricular (LV) and, for the first time, left atrial (LA) strain and strain rate in end-stage liver cirrhosis patients of different etiologies. Methods: This retrospective, cross-sectional study evaluated left heart function in 80 cirrhosis patients and 30 controls using standardized echocardiographic techniques and speckle tracking technology (STE) analysis. Serum markers of liver function were used for correlation analysis. Results: While conventional parameters demonstrated no alteration in systolic function, speckle tracking analysis showed a significant increase in LV longitudinal strain throughout all cardiac layers, with significant correlation to model of end-stage liver disease (MELD) score. LA reservoir and conduit strain as well as LA strain rate in all phases were significantly reduced in end-stage liver disease (ESLD) patients compared to control. STE for the evaluation of LA phasic function seemed to be more sensitive than volumetric methods. Kaplan–Meier curves showed a trend towards reduced post-transplant survival in patients with a reduced LA reservoir and conduit strain. Conclusion: STE analysis detected increased LV and decreased LA deformation in cirrhosis patients, thus proving to be highly sensitive to cardiac changes and useful for more precise cardiac evaluation.

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

“…This systematic review identified six cross-sectional [ 11 , 15 , 45 – 48 ], 6 case-control [ 10 , 49 – 53 ], and eight prospective cohort studies[ 14 , 36 , 54 – 59 ] gathered from 12 countries and consisting of 1738 participants ( Table 1 ). Our search strategy did not identify any randomized controlled trials.…”

“…We found one cross-sectional [ 15 ], one case-control [ 53 ], and three prospective cohort studies [ 14 , 55 , 59 ] providing results for GLS in both ventricles. 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. 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 ].…”

Diagnostic Criteria of Cirrhotic Cardiomyopathy

“…Recent studies show a correlation between abnormal GLS and mortality in patients with advanced cirrhosis. (8,9) There are some limitations of the Razpotnik et al study. They did not compare the prevalence of CCM among those with different severities of cirrhosis.…”

“…Recent studies show a correlation between abnormal GLS and mortality in patients with advanced cirrhosis. ( 8,9 )…”