Evaluation of Cardiac Systolic Function in Cirrhotic Patients Undergoing Liver Transplantation

  • Roya Sattarzadeh-Badkoubeh Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Babak Geraiely Mail Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohssen Nassiri-Toosi Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Jafarian Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Systolic function, Echocardiography, Cirrhosis, Liver transplantation

Abstract

We assessed different systolic cardiac indices to detect left and right ventricular systolic dysfunction in cirrhotic patients before liver transplantation. Between 2010-2011, 81 consecutive individuals with confirmed hepatic cirrhosis who were a candidate for liver transplantation were enrolled in this study. A total of 32 age and sex matched healthy volunteers were also selected as the control group. A detailed two-dimensional, Color Flow Doppler, and Tissue Doppler echocardiography were performed in all patients and control participants. Left atrial diameter and area, right atrial area, left ventricular enddiastolic volume, and basal right ventricular diameter were significantly higher in the cirrhotic group (P<0.05). Left ventricular ejection fraction, stroke volume, left ventricular outflow tract velocity time integral and tricuspid annular plane systolic excursion were also higher in the cirrhotic group (P<0.05). Peak systolic velocities of tricuspid annulus, basal segment of RV free wall and basal seg ent of septal wall, peak strains of basal and mid portions of septal wall, mid portion of lateral wall and peak strain rates of basal and mid portions of septal and lateral walls were higher significantly in cirrhotic group, as well (P<0.05). Isovolumic contraction time, LV systolic time interval and Tei indexes of left and right ventricles which all are representatives of systolic dysfunction were higher in cirrhosis. Peak systolic velocity of a mid-segment of the lateral wall was lower in the cirrhotic group (P<0.05) as well. Most of the cirrhotic patients display signs of cardiovascular disturbances that become more manifest following exposure to stresses such as transplantation. Cardiac failure is an important cause of death following liver transplantation. Because of the load dependency we cannot use most of the cardiac systolic indices for evaluatio of systolic function in cirrhotic patients. Thus, we suggest th t LV systolic time interval and Tei indices of left and right ventricles might be useful in ices in the evaluation of systolic function in cirrhotic patients.

References

Møller S, Henriksen JH. Cardiovascular complications of cirrhosis. Postgrad Med J 2009;85(999):44-54.

Liu H, Gaskari SA, Lee SS. Cardiac and vascular changes in cirrhosis: pathogenic mechanisms. World J Gastroenterol 2006;12(6):837-42.

Lee RF, Glenn TK, Lee SS. Cardiac dysfunction in cirrhosis. Best Pract Res Clin Gastroenterol 2007;21(1):125-40.

Huonker M, Schumacher YO, Ochs A, et al. Cardiac function and hemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt. Gut 1999:44(5):743-8.

Waleed K Alhamoodi. Cardiovascular Changes in Cirrhosis: Pathogenesis and Clinical Implications. Saudi J Gastroenterol 2010;16(3):145-53.

Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 2006;43(2 Suppl 1): S121-31.

Henriksen JH, Møller S. Cardiac and systemic hemodynamic complications of liver cirrhosis. Scand Cardiovasc J 2009;43(4):218-25.

Møller S, Søndergaard L, Møgelvang J, et al. Decreased right heart blood volume determined by magnetic resonance imaging: evidence of central underfilling in cirrhosis. Hepatology 1995;22(2):472-8.

Liu H, Lee S. Cardiopulmonary dysfunction in cirrhosis. J Gastroenterol Hepatol 1999:14(6):600-8.

Burcă P, Mihai B, Mihai C, et al. Cardiomyopathy in liver cirrhosis--an undiagnosed entity? Rev Med Chir Soc Med Nat Iasi 2010;114(2):319-26.

Vicario ML, Caso P, Martiniello AR, Fontanella L, et al. Effects of volume loading on strain rate and tissue Doppler velocity imaging in patients with idiopathic dilated cardiomyopathy. J Cardiovasc Med (Hagerstown) 2006;7(12):852-8.

Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18(12):1440-63

Wei Cui, Dvid A. Roberson Left Ventricular Tei Index in Children: Comparison of Tissue Doppler Imaging, Pulsed Wave Doppler, and M-Mode Echocardiography Normal Values, J Am Soc Echocardiogr 2006;19(12):1438-45.

Connolly HM. Echocardiography. In: Libby P, Bonow RO, Mann DL, editors. Braunwald's heart diseases. Text book of cardiovascular medicine. 8th ed. Saunders; 2007: p. 227-326.

Marwick TH. Measurement of strain and strain rate by echocardiography: ready for prime time? J Am Coll Cardiol 2006;47(7):1313-27.

Pozzi M, Carugo S, Boari G, et al. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. Hepatology 1997;26(5):1131-7.

Wong F, Girgrah N, Graba J, et al. The cardiac response to exercise in cirrhosis. Gut 2001;49(2):268-75.

Wong F. Cirrhotic Cardiomyopathy.Hepatol Int 2009:3(1):294-304.

Bernardi M, Rubboli A, Trevisani F, et al. Reduced cardiovascular responsiveness to exercise-induced sympathoadrencqglc stimulation in patients with cirrhosis. J Hepatol 1991;12(2):207-16.

Published
2015-10-06
How to Cite
1.
Sattarzadeh-Badkoubeh R, Geraiely B, Nassiri-Toosi M, Jafarian A. Evaluation of Cardiac Systolic Function in Cirrhotic Patients Undergoing Liver Transplantation. Acta Med Iran. 53(8):476-481.
Section
Original Article(s)