Left ventricular function assessment in cirrhosis: Current methods and future directions

Abstract

Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.

Keywords: Cardiomyopathy; Cirrhosis; Deformation imaging; Diastolic function; Echocardiography; Magnetic resonance imaging; Systolic function.

Figure 1

Ejection fraction determination using two-dimensional (biplane Simpson’s method - upper panel) and three-dimensional echocardiography (fully automated software - lower panel).

Figure 2

Left ventricular deformation analysis using speckle tracking echocardiography. Longitudinal (top panel) and circumferential (lower panel) strain curves are displayed.

Figure 3

Mitral inflow velocities using pulsed-wave Doppler showing a impaired relaxation pattern (top), and tissue-Doppler derived mitral annulus velocities at the septal wall (bottom).

Figure 4

Left atrial volume quantification using two-dimensional (biplane Simpson’s method - upper panel) and three-dimensional echocardiography (lower panel).

Figure 5

Left atrial deformation analysis using speckle tracking echocardiography. Reservoir, conduit and pump function of the left atrium during the cardiac cycle can be quantified from the strain curves.

Figure 6

Left ventricular deformation analysis using magnetic resonance feature tracking.