A Prospective Study of Prevalence and Predictors of Cirrhotic Cardiomyopathy and Its Role in Development of Hepatorenal Syndrome

Abstract

Background and aims: Cirrhotic cardiomyopathy (CCM) is a term used to collectively describe abnormal structural and functional changes in heart of patients with cirrhosis. The present study was undertaken to find the prevalence of CCM in patients with liver cirrhosis and its predictors. We also followed these patients to evaluate the role of CCM in the development of hepatorenal syndrome (HRS).

Materials & methods: This was a prospective study carried out in department of Gastroenterology, Sir Ganga Ram hospital, New Delhi. A total of 104 patients with liver cirrhosis were included. Liver cirrhosis was diagnosed on basis of clinical, biochemical, and imaging features. CCM was defined based on echocardiography. Dobutamine stress echocardiography and hepatic venous pressure gradient (HVPG) were performed in patients who gave consent. HRS was defined as per standard criteria. Patients with CCM were followed for development of HRS.

Results: Fifty (48%) patients were diagnosed with CCM. All patients had diastolic dysfunction, and none had systolic dysfunction. Median age of patients with CCM was significantly higher (59 [31-78 y] vs. 52 [24-70 y], P < 0.05). Severity of liver disease (Child Turcotte Pugh score and model for end-stage liver disease score) and portal pressures (HVPG) did not differ in patients with or without CCM. Patients with CCM did not have increased incidence of HRS at the end of 6-month follow-up study.

Conclusion: The presence of CCM was not related with the severity of liver dysfunction or portal pressures. Age was a significant determinant of CCM. Diastolic cardiac dysfunction does not influence the occurrence of HRS.

Keywords: 2D echo, two-dimensional echocardiography; CCM, cirrhotic cardiomyopathy; CTP, Child Turcotte Pugh; DD, diastolic dysfunction; DSE, dobutamine stress echocardiography; FHVP, free hepatic venous pressure; HRS, hepatorenal syndrome; HVPG, hepatic venous pressure gradient; LVEF, left ventricular ejection fraction; MELD, model for end-stage liver disease; TDI, tissue Doppler imaging; cardiomyopathy; cirrhosis; diastolic cardiac dysfunction; hepatorenal syndrome.

Figure 1

Patient enrollment.

Figure 2

Cirrhotic etiology in patients with and without CCM. Abbreviations: NAFLD: nonalcoholic fatty liver disease; CCM: cirrhotic cardiomyopathy; NS: not significant.

Figure 3

Comparison of HVPG, CTP, and MELD scores in patients with and without CCM; (A) HVPG, (B) CTP score, and (C) MELD score. None of the parameters showed any statistical difference between the two groups. Abbreviations: CTP: Child Turcotte Pugh; MELD: model for end-stage liver disease; HVPG: hepatic venous pressure gradient.