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The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients

Year 2022, , 10 - 16, 31.01.2022
https://doi.org/10.5472/marumj.1056204

Abstract

Objective: Cardiac dysfunction has been reported in both cirrhotic and alcoholic patients. Our aim was to determine the relation of serum N-terminal pro-B-type natriuretic peptide (Nt-proBNP) levels to myocardial performance index (MPI) and disease severity in nonalcoholic cirrhotic patients.

Patients and Methods: In this prospective study including 25 cirrhotic patients and 27 healthy controls, MPI was assessed by pulsed-wave tissue Doppler imaging (PW-TDI). The disease severity was determined by Child–Turcotte–Pugh (CTP ) and model for end-stage liver disease (MELD) scores.

Results: There were no statistically significant differences in MPI levels between patients and controls (p< 0.246). Nt-proBNP levels (p< 0.0003), cardiac output (CO) (p< 0.0002), left ventricular end-systolic (LVES) volume (p< 0.031) and QT interval (p< 0.0001) increased. Left ventricular systolic function was normal in all cirrhotic patients when compared to controls. Nt-proBNP levels were positively correlated with MELD scores (p< 0.0001, r= 0.59), QT duration (p< 0.0001, r= 0.59), CO (p= 0,001, r= 0.44), right atrial (RA) area (p= 0.026, r= 0.31) and negatively correlated with diastolic BP (p= 0.015, r= -0.34).

Conclusion: We conclude that in nonalcoholic cirrhotic patients, left ventricular MPI and systolic function were normal. Nt-proBNP levels were correlated with the disease severity and hyperdynamic circulation.

References

  • Møller S, Danielsen KV, Wiese S, Hove JD, Bendtsen F. An update on cirrhotic cardiomyopathy. Expert Rev Gastroenterol Hepatol 2019; 13: 497-505. doi: 10.1080/17474124.2019.1587293.
  • Mirijello A, Tarli C, Vassallo GA, et al. Alcoholic cardiomyopathy: What is known and what is not known. Eur J Intern Med 2017;43: 1-5. doi: 10.1016/j.ejim.2017.06.014.
  • Rubattu S, Sciarretta S, Valenti V, Stanzione R, Volpe M. Natriuretic peptides: an update on bioactivity, potential therapeutic use, and implication in cardiovascular diseases. Am J Hypertens 2008; 21: 733-41. doi: 10.1038/ajh.2008.174.
  • Raedle-Hurst TM, Welsch C, Forestier N, et al. Validity of N-terminal propeptide of the brain natriuretic peptide in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease. Eur J Gastroenterol Hepatol 2008; 20: 865-73. doi: 10.1097/MEG.0b013e3282fb7cd0.
  • Wong F, Siu S, Liu P, Blendis LM. Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis? Clinical Science (Lond) 2001; 101: 621-8.
  • Abbas WA, Kasem Ahmed SM, Abdel Aal AM, et al. Galactin-3 and brain natriuretic peptide versus conventional echocardiography in the early detection of cirrhotic cardiomyopathy. Turk J Gastroenterol 2016; 27: 367-74. doi: 10.5152/tjg.2016.16100.
  • Yildiz R, Yildirim B, Karincaoglu M, Harputluoglu M, Hilmioglu F. Brain natriuretic peptide and severity of disease in non-alcoholic cirrhotic patients. J Gastroenterol Hepatol 2005; 20: 1115-20. doi: 10.1111/j.1440-1746.2005.03906.x.
  • Metwaly A, Khalik AA, Nasr FM, Sabry AI, Gouda MF, Hassan M. Brain natriuretic peptide in liver cirrhosis and fatty liver: Correlation with cardiac performance. Electron Physician 2016; 8:1984-93. doi: 10.19082/1984.
  • Shi LY, Jin R, Lin CJ, et al. B-type natriuretic peptide and cirrhosis progression. Genet Mol Res 2015; 14: 5188-96. doi: 10.4238/2015.May.18.9.
  • Wang LK, An XF, Wu XL et al. Doppler myocardial performance index combined with plasma B-type natriuretic peptide levels as a marker of cardiac function in patients with decompensated cirrhosis. Medicine (Baltimore) 2018; 97: e13302. doi: 10.1097/MD.0000000000013302.
  • Pimenta J, Paulo C, Gomes A, Silva S, Rocha-Gonçalves F, Bettencourt P. B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis. Liver Int 2010; 30: 1059-66. doi: 10.1111/j.1478-3231.2010.02266.x.
  • Pellett AA, Tolar WG, Merwin DG, Kerut EK. The Tei index: methodology and disease state values. Echocardiography 2004; 21: 669-72. doi: 10.1111/j.0742-2822.2004.04052.x.
  • Gaibazzi N, Petrucci N, Ziacchi V. Left ventricle myocardial performance index derived either by conventional method or mitral annulus tissue-Doppler: a comparison study in healthy subjects and subjects with heart failure. J Am Soc Echocardiogr 2005; 18: 1270-6. doi: 10.1016/j.echo.2005.06.006.
  • Fattouh AM, El-Shabrawi MH, Mahmoud EH, Ahmed WO. Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue Doppler imaging. Ann Pediatr Cardiol 2016; 9: 22-8. doi: 10.4103/0974-2069.171373.
  • Ashmawy MM, Younis HA, Elbaset MAA, et al. Evaluation of cardiac function in patients with liver cirrhosis using tissue Doppler study. Egypt J Intern Med 2018; 30: 115-20. doi:10.4103/ejim.ejim_28_18.
  • Song Y, Li W, Xue H, Ruan L. Tei index is associated with survival in cirrhosis patients treated with transjugular intrahepatic portosystemic shunt. Echocardiography 2019; 36: 61-66. doi: 10.1111/echo.14201.
  • Amoozgar H, Ermis R, Honar N, Malek-Hosseini SA. Myocardial performance after successful liver transplantation. Int J Organ Transplant Med 2016; 7: 77-83.
  • Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. doi: 10.1016/j.echo.2014.10.003.
  • Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277-314. doi: 10.1016/j.echo.2016.01.011.
  • Armstrong WF, Ryan T. Feigenbaum’s Echocardiography. 8th ed. Hemodynamics Chapter 8. Philadelphia: Lippincott Williams and Wilkins, 2018:648-9.
  • Su HM, Lin TH, Voon WC, et al. Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography. Echocardiography 2006; 23: 287-94. doi: 10.1111/j.1540-8175.2006.00222.x.
  • Nayor M, Cooper LL, Enserro DM, et al. Left ventricular diastolic dysfunction in the community: Impact of diagnostic criteria on the burden, correlates, and prognosis. J Am Heart Assoc 2018; 7: e008291. doi: 10.1161/JAHA.117.008291.
  • Henriksen JH, Gøtze JP, Fuglsang S, Christensen E, Bendtsen F, Møller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut 2003; 52:1511-7. doi: 10.1136/gut.52.10.1511.
  • Wiese S, Hove JD, Mo S, et al. Cardiac dysfunction in cirrhosis: a 2-yr longitudinal follow-up study using advanced cardiac imaging. Am J Physiol Gastrointest Liver Physiol 2019; 317: G253-G263. doi: 10.1152/ajpgi.00402.2018.
  • Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quiñones MA, Zoghbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation 1998; 98:1644-50. doi: 10.1161/01.cir.98.16.1644.
  • Barbosa M, Guardado J, Marinho C, et al. Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis? World J Hepatol 2016; 8: 200-6. doi: 10.4254/wjh.v8.i3.200.
  • Saner FH, Neumann T, Canbay A, et al. High brain-natriuretic peptide level predicts cirrhotic cardiomyopathy in liver transplant patients. Transpl Int 2011; 24: 425-32. doi: 10.1111/j.1432-2277.2011.01219.x.
  • Padillo J, Rioja P, Muñoz-Villanueva MC, et al. BNP as marker of heart dysfunction in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2010; 22:1331-6. doi: 10.1097/MEG.0b013e32833e6b2a.
  • Falletta C, Filì D, Nugara C, et al. Diastolic dysfunction diagnosed by tissue Doppler imaging in cirrhotic patients: Prevalence and its possible relationship with clinical outcome. Eur J Intern Med 2015; 26: 830-4. doi: 10.1016/j.ejim.2015.10.009.
  • Bernardi M, Calandra S, Colantoni A, et al. Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology 1998; 27: 28-34. doi: 10.1002/hep.510270106.
  • Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in patients with cirrhosis. J Hepatol 2006; 44: 994-1002. doi: 10.1016/j.jhep.2005.10.034.
  • Zhang K, Braun A, von Koeckritz F, et al. Right heart remodeling in patients with end-stage alcoholic liver cirrhosis: speckle tracking point of view. J Clin Med 2019; 8:1285. doi: 10.3390/jcm8091285.
  • Parvinian A, Bui JT, Knuttinen MG, Minocha J, Gaba RC. Right atrial pressure may impact early survival of patients undergoing transjugular intrahepatic portosystemic shunt creation. Ann Hepatol 2014;13: 411-9. doi:10.1016/S1665-2681(19)30848-8.
  • Karabulut A, Iltumur K, Yalcin K, Toprak N. Hepatopulmonary syndrome and right ventricular diastolic functions: an echocardiographic examination. Echocardiography 2006 23: 271-8. doi: 10.1111/j.1540-8175.2006.00210.x.
Year 2022, , 10 - 16, 31.01.2022
https://doi.org/10.5472/marumj.1056204

Abstract

References

  • Møller S, Danielsen KV, Wiese S, Hove JD, Bendtsen F. An update on cirrhotic cardiomyopathy. Expert Rev Gastroenterol Hepatol 2019; 13: 497-505. doi: 10.1080/17474124.2019.1587293.
  • Mirijello A, Tarli C, Vassallo GA, et al. Alcoholic cardiomyopathy: What is known and what is not known. Eur J Intern Med 2017;43: 1-5. doi: 10.1016/j.ejim.2017.06.014.
  • Rubattu S, Sciarretta S, Valenti V, Stanzione R, Volpe M. Natriuretic peptides: an update on bioactivity, potential therapeutic use, and implication in cardiovascular diseases. Am J Hypertens 2008; 21: 733-41. doi: 10.1038/ajh.2008.174.
  • Raedle-Hurst TM, Welsch C, Forestier N, et al. Validity of N-terminal propeptide of the brain natriuretic peptide in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease. Eur J Gastroenterol Hepatol 2008; 20: 865-73. doi: 10.1097/MEG.0b013e3282fb7cd0.
  • Wong F, Siu S, Liu P, Blendis LM. Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis? Clinical Science (Lond) 2001; 101: 621-8.
  • Abbas WA, Kasem Ahmed SM, Abdel Aal AM, et al. Galactin-3 and brain natriuretic peptide versus conventional echocardiography in the early detection of cirrhotic cardiomyopathy. Turk J Gastroenterol 2016; 27: 367-74. doi: 10.5152/tjg.2016.16100.
  • Yildiz R, Yildirim B, Karincaoglu M, Harputluoglu M, Hilmioglu F. Brain natriuretic peptide and severity of disease in non-alcoholic cirrhotic patients. J Gastroenterol Hepatol 2005; 20: 1115-20. doi: 10.1111/j.1440-1746.2005.03906.x.
  • Metwaly A, Khalik AA, Nasr FM, Sabry AI, Gouda MF, Hassan M. Brain natriuretic peptide in liver cirrhosis and fatty liver: Correlation with cardiac performance. Electron Physician 2016; 8:1984-93. doi: 10.19082/1984.
  • Shi LY, Jin R, Lin CJ, et al. B-type natriuretic peptide and cirrhosis progression. Genet Mol Res 2015; 14: 5188-96. doi: 10.4238/2015.May.18.9.
  • Wang LK, An XF, Wu XL et al. Doppler myocardial performance index combined with plasma B-type natriuretic peptide levels as a marker of cardiac function in patients with decompensated cirrhosis. Medicine (Baltimore) 2018; 97: e13302. doi: 10.1097/MD.0000000000013302.
  • Pimenta J, Paulo C, Gomes A, Silva S, Rocha-Gonçalves F, Bettencourt P. B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis. Liver Int 2010; 30: 1059-66. doi: 10.1111/j.1478-3231.2010.02266.x.
  • Pellett AA, Tolar WG, Merwin DG, Kerut EK. The Tei index: methodology and disease state values. Echocardiography 2004; 21: 669-72. doi: 10.1111/j.0742-2822.2004.04052.x.
  • Gaibazzi N, Petrucci N, Ziacchi V. Left ventricle myocardial performance index derived either by conventional method or mitral annulus tissue-Doppler: a comparison study in healthy subjects and subjects with heart failure. J Am Soc Echocardiogr 2005; 18: 1270-6. doi: 10.1016/j.echo.2005.06.006.
  • Fattouh AM, El-Shabrawi MH, Mahmoud EH, Ahmed WO. Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue Doppler imaging. Ann Pediatr Cardiol 2016; 9: 22-8. doi: 10.4103/0974-2069.171373.
  • Ashmawy MM, Younis HA, Elbaset MAA, et al. Evaluation of cardiac function in patients with liver cirrhosis using tissue Doppler study. Egypt J Intern Med 2018; 30: 115-20. doi:10.4103/ejim.ejim_28_18.
  • Song Y, Li W, Xue H, Ruan L. Tei index is associated with survival in cirrhosis patients treated with transjugular intrahepatic portosystemic shunt. Echocardiography 2019; 36: 61-66. doi: 10.1111/echo.14201.
  • Amoozgar H, Ermis R, Honar N, Malek-Hosseini SA. Myocardial performance after successful liver transplantation. Int J Organ Transplant Med 2016; 7: 77-83.
  • Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. doi: 10.1016/j.echo.2014.10.003.
  • Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277-314. doi: 10.1016/j.echo.2016.01.011.
  • Armstrong WF, Ryan T. Feigenbaum’s Echocardiography. 8th ed. Hemodynamics Chapter 8. Philadelphia: Lippincott Williams and Wilkins, 2018:648-9.
  • Su HM, Lin TH, Voon WC, et al. Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography. Echocardiography 2006; 23: 287-94. doi: 10.1111/j.1540-8175.2006.00222.x.
  • Nayor M, Cooper LL, Enserro DM, et al. Left ventricular diastolic dysfunction in the community: Impact of diagnostic criteria on the burden, correlates, and prognosis. J Am Heart Assoc 2018; 7: e008291. doi: 10.1161/JAHA.117.008291.
  • Henriksen JH, Gøtze JP, Fuglsang S, Christensen E, Bendtsen F, Møller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut 2003; 52:1511-7. doi: 10.1136/gut.52.10.1511.
  • Wiese S, Hove JD, Mo S, et al. Cardiac dysfunction in cirrhosis: a 2-yr longitudinal follow-up study using advanced cardiac imaging. Am J Physiol Gastrointest Liver Physiol 2019; 317: G253-G263. doi: 10.1152/ajpgi.00402.2018.
  • Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quiñones MA, Zoghbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation 1998; 98:1644-50. doi: 10.1161/01.cir.98.16.1644.
  • Barbosa M, Guardado J, Marinho C, et al. Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis? World J Hepatol 2016; 8: 200-6. doi: 10.4254/wjh.v8.i3.200.
  • Saner FH, Neumann T, Canbay A, et al. High brain-natriuretic peptide level predicts cirrhotic cardiomyopathy in liver transplant patients. Transpl Int 2011; 24: 425-32. doi: 10.1111/j.1432-2277.2011.01219.x.
  • Padillo J, Rioja P, Muñoz-Villanueva MC, et al. BNP as marker of heart dysfunction in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2010; 22:1331-6. doi: 10.1097/MEG.0b013e32833e6b2a.
  • Falletta C, Filì D, Nugara C, et al. Diastolic dysfunction diagnosed by tissue Doppler imaging in cirrhotic patients: Prevalence and its possible relationship with clinical outcome. Eur J Intern Med 2015; 26: 830-4. doi: 10.1016/j.ejim.2015.10.009.
  • Bernardi M, Calandra S, Colantoni A, et al. Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology 1998; 27: 28-34. doi: 10.1002/hep.510270106.
  • Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in patients with cirrhosis. J Hepatol 2006; 44: 994-1002. doi: 10.1016/j.jhep.2005.10.034.
  • Zhang K, Braun A, von Koeckritz F, et al. Right heart remodeling in patients with end-stage alcoholic liver cirrhosis: speckle tracking point of view. J Clin Med 2019; 8:1285. doi: 10.3390/jcm8091285.
  • Parvinian A, Bui JT, Knuttinen MG, Minocha J, Gaba RC. Right atrial pressure may impact early survival of patients undergoing transjugular intrahepatic portosystemic shunt creation. Ann Hepatol 2014;13: 411-9. doi:10.1016/S1665-2681(19)30848-8.
  • Karabulut A, Iltumur K, Yalcin K, Toprak N. Hepatopulmonary syndrome and right ventricular diastolic functions: an echocardiographic examination. Echocardiography 2006 23: 271-8. doi: 10.1111/j.1540-8175.2006.00210.x.
There are 34 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Research
Authors

Sena Tokay Tarhan This is me 0000-0002-5300-6460

Feruze Yılmaz Enç This is me 0000-0001-9758-7730

Fatih Eren This is me 0000-0001-8126-2413

Ali Serdar Fak This is me 0000-0002-1732-4891

Osman Özdoğan This is me 0000-0003-4801-7314

Publication Date January 31, 2022
Published in Issue Year 2022

Cite

APA Tokay Tarhan, S., Yılmaz Enç, F., Eren, F., Fak, A. S., et al. (2022). The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients. Marmara Medical Journal, 35(1), 10-16. https://doi.org/10.5472/marumj.1056204
AMA Tokay Tarhan S, Yılmaz Enç F, Eren F, Fak AS, Özdoğan O. The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients. Marmara Med J. January 2022;35(1):10-16. doi:10.5472/marumj.1056204
Chicago Tokay Tarhan, Sena, Feruze Yılmaz Enç, Fatih Eren, Ali Serdar Fak, and Osman Özdoğan. “The Role of Myocardial Performance Index and Nt-ProBNP Levels As a Marker of Heart Dysfunction in Nonalcoholic Cirrhotic Patients”. Marmara Medical Journal 35, no. 1 (January 2022): 10-16. https://doi.org/10.5472/marumj.1056204.
EndNote Tokay Tarhan S, Yılmaz Enç F, Eren F, Fak AS, Özdoğan O (January 1, 2022) The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients. Marmara Medical Journal 35 1 10–16.
IEEE S. Tokay Tarhan, F. Yılmaz Enç, F. Eren, A. S. Fak, and O. Özdoğan, “The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients”, Marmara Med J, vol. 35, no. 1, pp. 10–16, 2022, doi: 10.5472/marumj.1056204.
ISNAD Tokay Tarhan, Sena et al. “The Role of Myocardial Performance Index and Nt-ProBNP Levels As a Marker of Heart Dysfunction in Nonalcoholic Cirrhotic Patients”. Marmara Medical Journal 35/1 (January 2022), 10-16. https://doi.org/10.5472/marumj.1056204.
JAMA Tokay Tarhan S, Yılmaz Enç F, Eren F, Fak AS, Özdoğan O. The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients. Marmara Med J. 2022;35:10–16.
MLA Tokay Tarhan, Sena et al. “The Role of Myocardial Performance Index and Nt-ProBNP Levels As a Marker of Heart Dysfunction in Nonalcoholic Cirrhotic Patients”. Marmara Medical Journal, vol. 35, no. 1, 2022, pp. 10-16, doi:10.5472/marumj.1056204.
Vancouver Tokay Tarhan S, Yılmaz Enç F, Eren F, Fak AS, Özdoğan O. The role of myocardial performance index and Nt-proBNP levels as a marker of heart dysfunction in nonalcoholic cirrhotic patients. Marmara Med J. 2022;35(1):10-6.