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

Yıl 2022, Cilt: 35 Sayı: 1, 10 - 16, 31.01.2022

Sena Tokay Tarhan Feruze Yılmaz Enç Fatih Eren Ali Serdar Fak Osman Özdoğan

https://doi.org/10.5472/marumj.1056204

Cited By: 1

Öz

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.

Anahtar Kelimeler

Cirrhosis, Heart failure, Nt-proBNP, Echocardiography

Kaynakça

• 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.