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. 2021 Apr-Jun;22(2):96-101.
doi: 10.4103/HEARTVIEWS.HEARTVIEWS_14_21. Epub 2021 Aug 19.

Morphological Cardiac Alterations in Liver Cirrhosis: An Autopsy Study

Banushree Chandrasekhar Srinivasamurthy  1 , Sanjay P Saravanan  1 , Fremingston K Marak  2 , Prakash Manivel  3 , Ramachandra V Bhat  1 , Dharanya Mathiyazhagan  1
Affiliations

Morphological Cardiac Alterations in Liver Cirrhosis: An Autopsy Study

Banushree Chandrasekhar Srinivasamurthy et al. Heart Views. 2021 Apr-Jun.

Abstract

Background: Cirrhosis can cause various cardiac complications and severely affect the prognosis of the patient suffering from cirrhosis. Anatomical, morphological variations in the heart of patients with liver cirrhosis in the absence of known cardiac disease has not been well described. There is a paucity of studies in the literature on cardiac alterations in cirrhosis. Early detection of known cardiac alterations can further help in improving the quality of life.

Materials and methods: A cross-sectional descriptive study was conducted in the departments of pathology and forensic medicine of our institution. An autopsy-based prospective study of forty consecutive patients with final diagnosis of liver cirrhosis were included. Patients with a known history of cardiac disease/anomaly were excluded from the study. Macroscopic and microscopic changes in the heart and coronaries were noted and statistically analyzed.

Results: Analysis of the hearts on gross examination showed cardiomegaly in 31 patients (77.5%). All cases had left ventricular hypertrophy. Endocardial thickening was seen in 22 patients (55%). Calcified mitral valve was seen in 9 patients (22.5%).On microscopy, apart from hypertrophy, the pathological changes like interstitial oedema (47.5%), fibrosis (45%), cardiac muscle disarray (87.5%), fatty infiltrate (10%), pericarditis (5%), and severe coronary artery atherosclerosis (17.5%) were seen in the patients.

Conclusion: Knowledge about the involvement of the heart in liver cirrhosis is essential for both the physician and the surgeons to prevent adverse outcomes during liver transplantation and can further help in improving the quality of life of the patient.

Keywords: Cardiomyopathy; cirrhosis; fibrosis; ventricular hypertrophy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) External surface of the heart in a 42-year-old male with alcoholic cirrhosis showing cardiomegaly. (b) Four-chamber view showing the left ventricular wall, interventricular septum, and papillary muscle hypertrophy
Figure 2
Figure 2
(a) External surface of a 36-year-old male with liver cirrhosis showing a significant increase in epicardial fat. (b) Microphotographs show myofibers separated by adipocytes
Figure 3
Figure 3
(a) Photomicrograph shows interstitial edema and myofiber disarray. (b) Photomicrograph shows patchy fibrosis in a 42-year-old male patient with cirrhosis
Figure 4
Figure 4
(a) Microphotograph of myocardium shows edema and acute inflammatory infiltrate in a 48-year-old male with cirrhosis of the liver. (b) Microphotograph of the left anterior descending artery showing near-complete occlusion of the lumen by atherosclerosis in the same patient. (c) Masson's trichrome staining of the ventricular section shows dead muscle fibers (red) within the collagen-rich scar (blue)
See this image and copyright information in PMC

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