In HCV-related liver cirrhosis, local pulse wave velocity increases and in decompensated patients correlates with poorer survival

Abstract

Background: Cirrhotic cardiomyopathy (CCM) refers to cardiac dysfunction in patients with liver cirrhosis, in the absence of other known cardiac disease.

Methods: Control group and patients diagnosed of liver cirrhosis without known cardiac disease or hepatocellular carcinoma were enrolled for this clinical observation study. Patients with diabetes mellitus, hypertension were excluded. Absolute global longitudinal strain, one-point carotid pulse wave velocity (one-point PWV) and various parameters were measured in resting status.

Results: There were 29 participants in the control group and 80 patients in the liver cirrhosis group. 27.8% of cirrhotic patients presented with normal systolic but abnormal diastolic functions and QTc prolongation that were compatible with CCM. 34.2% of cirrhotic patients presented with diastolic dysfunction in resting state comparing to 24.1% in control group. Systolic functions did not show conspicuous difference between cirrhosis and control group nor between compensated and decompensated cirrhosis, neither. Furthermore, one-point PWV was significantly higher in liver cirrhosis than in control group and higher in CCM than in non-CCM patients. One-point PWV predicted CCM and diastolic dysfunction in cirrhosis. Most importantly, its value > 1370cm/s predicted overall mortalities in decompensated cirrhosis (multivariable Cox analysis OR = 6.941) in addition to CTP score specifically in HCV related cirrhotic patients (AUC = 0.817).

Conclusions: In patients with cirrhosis, 27.8% were diagnosed with CCM by resting cardiovascular parameters. One-point PWV increased in CCM, correlated with diastolic dysfunction. It also correlated with overall mortality in patients with hepatitis C virus (HCV) related decompensated cirrhosis. Further study may be needed to confirm its capability for assessing CV and mortality risks in HCV related decompensated cirrhotic patients.

Fig 1. The AUC of one-point PWV in predicting mortalities in patients with HCV related decompensated cirrhosis.

By Youden’s index to determine the best cut-off value (highest value of sensitivity+specificity-1), one-point of PWV> 1370 cm/s was the best cut-off value in predicting mortalities for HCV related decompensated cirrhosis (AUROC = 0.813, p = 0.034).

Fig 2. The Kaplan–Meier plot of one-point PWV> or <1370 cm/s predicted mortalities of patients with HCV related decompensated cirrhosis (Log-rank test p = 0.0216).

The number of patients at risk on each time point is also shown in the bottom of the figure.