Ventricular function in cirrhosis and portasystemic shunt: A two-dimensional echocardiographic study

Abstract

Cardiovascular alterations such as increased heart rate, high cardiac output, reduced systemic vascular resistance, and in most of the cases, increased contractility parameters have been recognized in patients with advanced liver disease. Some investigators define a cirrhotic cardiomyopathy as a hyperdynamic failure of the heart. Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. After opening a portocaval shunt, it is expected that a large amount of blood will be distributed from the splanchnic to the pulmonary circulation and put a strain on the heart. This two-dimensional echocardiographic study was made in 30 patients with cirrhosis and in 20 patients who were chronically treated (range: 16 to 156 months) with portasystemic shunt for prevention of hemorrhage from esophageal variceal bleeding. Patients with portasystemic shunts revealed a change in hemodynamic pattern. There was a significant increase in the left ventricular end-diastolic volume index and also a slight increase in the left ventricular end-systolic index. Cardiac output remained high despite a significant decrease in heart rate due to an elevated left ventricular stroke volume index. The parameters of systolic ventricular performance were normal. In contrast to the acute opening of the portacaval shunt, the chronic shunt volume put no strain of clinical significance on the heart.

Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt

“…These findings are supported by another echocardiographic study18 of cirrhotic patients, mainly chronic alcoholics, with an elevated left ventricular end diastolic volume index, whereas the left ventricular end systolic volume index was almost unchanged compared with healthly adults. In contrast, Askansis et al 19showed increased end diastolic and end systolic left ventricular volumes in chronic alcoholics, indicating an additional systolic dysfunction.…”

Elevated Circulating Cardiac Troponin I in Patients With Cirrhosis

“…[2][3][4]22,23 Certain echocardiographic studies have shown a significant increase in left ventricular end diastolic volume index and elevated left ventricular stroke volume index in these patients. 24 In fact, ventricular hyporesponsiveness has been shown to occur in patients with cirrhosis under physiological stress, resulting in tissue oxygen consumption increases that may not be satisfied by cardiac function. For example, one study has shown that cardiac stroke index does not increase but may even decrease in some patients with cirrhosis during exercise.…”

The heart in liver transplantation

“…Many subtle changes in cardiac morphology have been described using this technique, including an increase in left and right ventricular cavity size, as well as an increased thickness of the left ventricle wall [91][92][93][94][95]. Additionally, if tricuspid regurgitation is detected, right ventricle systolic pressure or pulmonary artery pressure can be estimated with Doppler echocardiography.…”