Right ventricular dysfunction in cirrhosis: A speckle-tracking echocardiography study

Abstract

Aim: The majority of studies on cardiac dysfunction in patients with cirrhosis are associated with left ventricular (LV) myocardial dysfunction, with fewer studies on right ventricular (RV) function. The aims of this study were to evaluate biventricular function, particularly RV function, in patients with cirrhosis and investigate its relationship with disease severity. Methods: We included 50 hospitalized and ambulatory patients with cirrhosis and 33 healthy controls. Echocardiographic evaluation was performed with speckle-tracking analysis. Liver disease was graded according to Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Results: In our study, the most prevalent etiology of cirrhosis was viral hepatitis (60%), followed by non-alcoholic fatty liver disease (24%). RV-global longitudinal strain (GLS) and LV ejection fraction (EF) values were lower in patients with cirrhosis compared to the control group (both, P=0.001). LVEF was <55% in 19 (38%) patients. Decreases in RV-GLS and LVEF values were more common in patients with ascites (both, P=0.001). However, measurements of RV-GLS and LVEF did not distinguish the degree of severity of liver disease on the basis of Child-Pugh and MELD scores. LV-GLS values between patients with cirrhosis and the control group were similar (P=0.896). Conclusions: This study showed that RV function was impaired in patients with cirrhosis and more commonly, in patients with ascites. However, values of RV-GLS did not distinguish the degree of severity of liver disease. In addition, the LVEF was low and LV-GLS was normal in patients with cirrhosis.

Keywords

• Cirrhotic cardiomyopathy
• right ventricular dysfunction
• echocardiography
• speckle-tracking analysis

Sirozda sağ ventrikül disfonksiyonu: Speckle-tracking ekokardiyografi çalışması

Öz

Amaç: Sirozlu hastalarda kardiyak disfonksiyon üzerine yapılan çalışmaların çoğu, sol ventriküler (LV) miyokardiyal disfonksiyon ile ilişkilidir ve sağ ventrikül (RV) fonksiyonu üzerine daha az çalışma vardır. Bu çalışmanın amacı sirozlu hastalarda özellikle RV fonksiyonu olmak üzere, biventriküler fonksiyonu değerlendirmek ve hastalık şiddeti ile ilişkisini araştırmaktır. Yöntemler: Hastanede yatan ve ayakta tedavi gören 50 siroz hastası ve 33 sağlıklı kontrol çalışmamıza dahil edildi. Ekokardiyografik değerlendirme speckle-tracking analizi ile yapıldı. Karaciğer hastalığı Child-Pugh ve Son Evre Karaciğer Hastalığı Modeli (MELD) puanlarına göre derecelendirildi. Bulgular: Çalışmamızda sirozun en yaygın etiyolojisi viral hepatit (%60), ardından non-alkolik yağlı karaciğer hastalığı (%24) idi. Sirozlu hastalarda RV-global longitudinal strain (GLS) ve LV ejeksiyon fraksiyonu (EF) değerleri kontrol grubuna göre daha düşüktü (her ikisi de P=0.001). LVEF, 19 (% 38) hastada < %55 idi. Asitli hastalarda RV-GLS ve LVEF değerlerindeki düşüşler daha sıktı (her ikisi de, P=0,001). Bununla birlikte, RV-GLS ve LVEF ölçümleri, Child-Pugh ve MELD skorlarına göre karaciğer hastalığının şiddet derecesini ayırt etmedi. Sirozlu hastalar ile kontrol grubu arasındaki LV-GLS değerleri benzerdi (P=0.896). Sonuç: Bu çalışma, RV fonksiyonunun sirozlu hastalarda ve daha sık olarak asitli hastalarda bozulduğunu göstermiştir. Bununla birlikte, RV-GLS değerleri, karaciğer hastalığının şiddet derecesini ayırt etmedi. Ayrıca sirozlu hastalarda LVEF düşüktü ve LV-GLS normaldi.

Anahtar Kelimeler

• Sirotik kardiyomiyopati
• Sağ ventrikül disfonksiyonu
• Ekokardiyografi
• Speckle-tracking analizi

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