Correlates of diastolic function in patients with alcoholic liver cirrhosis
Abstract
Introduction: There are few established correlations between echocardiographic and biological parameters, and the severity of hepatic alcoholic disease; and even fewer prognostic correlations.
Objective: The present study is aiming at establishing correlations between severity of hepatic alcoholic disease and cardiac structural and functional alterations, as well as their prognostic implications.
Method: We investigated a group of 50 patients with liver cirrhosis of alcoholic etiology, classified by Child-Pugh score. Routine laboratory tests and transthoracic echocardiography were performed, NT-proBNP level was measured in each.
Results: We found that patients with more severe liver dysfunction have a significantly worse diastolic profile. The peak early diastolic filling velocity of the left ventricle (E wave) was significantly higher, with lower tissue Doppler velocities at annular level and high ratio between E and e’, which point to the severity of the diastolic dysfunction. When comparing the indexed volumes of heart cavities, we did not find significant differences regarding left atrium indexed volume, left ventricle end-diastolic or end-systolic indexed volumes. Patients with Child class B liver disease had significantly lower levels of NT-proBNP.
Conclusions: This study is revealing the significant association between diastolic dysfunction of the left ventricle and severity of the alcoholic liver cirrhosis, as well as the correlation between E/e’ ratio value, Child-Pugh class and also higher values of NT-proBNP. The benefit is that patients with alcoholic cirrhosis can be also classified according to the existence and severity of left ventricular diastolic dysfunction so that these patients could benefit from a stricter monitoring and closer follow-up.
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1. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006;166(22):2437-45.
2. Capasso JM, Li P, Guideri G, Malhotra A, Cortese R, Anversa P. Myocardial mechanical, biochemical, and structural alterations induced by chronic ethanol ingestion in rats. Circ Res. 1992;71(2):346-56.
3. Schoppet M, Maisch B. Alcohol and the heart. Herz. 2001;26(5):345-52.
4. Delbridge LM, Connell PJ, Harris PJ, Morgan TO. Ethanol effects on cardiomyocyte contractility. Clin Sci (Lond). 2000;98(4):401-7.
5. Hines LM, Stampfer MJ, Ma J, Gaziano JM, Ridker PM, Hankinson SE, et al. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction. N Engl J Med. 2001;344(8):549-55.
6. Fernández-Solá J, Nicolas JM, Oriola J, Sacanella E, Estruch R, Rubin E, et al. Angiotensin-converting enzyme gene polymorphism is associated with vulnerability to alcoholic cardiomyopathy. Ann Intern Med. 2002;137(5 Part 1):321-6.
7. Djoussé L, Gaziano JM. Alcohol consumption and heart failure: A systematic review. Curr Atheroscler Rep. 2008;10(2):117-20.
8. Iacovoni A, de Maria R, Gavazzi A. Alcoholic cardiomyopathy. J Cardiovasc Med (Hagerstown). 2010;11(12):884-92.
9. Klein AL, Burstow DJ, Tajik AJ, Zachariak PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69(3):212-24.
10. Kazankov K, Holland-Fischer P, Andersen NH, Torp P, Sloth E, Aagaard NK, et al. Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging. Liver Int. 2011;31(4):534-40.
11. Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, et al. Systolic and diastolic dysfunction in cirrhosis: A tissue-Doppler and speckle tracking echocardiography study. Liver Int. 2013;33(8):1158-65.
12. Karagiannakis DS, Vlachogiannakos J, Anastasiadis G, Vafiadis-Zouboulis I, Ladas SD. Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis. Hepatol Int. 2014;8(4):588-94.
13. Ruíz-del-Árbol L, Achécar L, Serradilla R, Rodríguez-Gandía MÁ, Rivero M, Garrido E, et al. Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology. 2013;58(5):1732-41.
14. Moller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34(36):2804-11.
15. Alqahtani SA, Fouad TR, Lee SS. Cirrhotic cardiomyopathy. Semin Liver Dis. 2008;28(1):59-69.
16. Henriksen JH, Gotze JP, Fuglsang S, Christensen E, Bendtsen F, Moller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut. 2003;52(10):1511-7.
17. Pimenta J, Paulo C, Gomes A, Silva S, Rocha-Gonçalves F, Bettencourt P. B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis. Liver Int. 2010;30(7):1059-66.
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