Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis

다국어 초록 (Multilingual Abstract)

Background/Aims: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC.
Methods: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary’s Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival.
Results: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e’) ≥ 10 (LVDD grade 2) had lower survival than patients with E/e’ ratio < 10.
Conclusions: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

참고문헌 (Reference)

1 Pugh RN, "Transection of the oesophagus for bleeding oesophageal varices" 60 : 646-649, 1973

2 하종원, "Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective" 한국심초음파학회 17 (17): 86-95, 2009

3 Krag A, "The window hypothesis : haemodynamic and non-haemodynamic effects of β-blockers improve survival of patients with cirrhosis during a window in the disease" 61 : 967-969, 2012

4 Kwon JH, "The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis" 15 : 146-, 2015

5 Lim YS, "The global impact of hepatic fibrosis and endstage liver disease" 12 : 733-746, 2008

6 Jepsen P, "The clinical course of cirrhosis : the importance of multistate models and competing risks analysis" 62 : 292-302, 2015

7 Ge PS, "The changing role of beta-blocker therapy in patients with cirrhosis" 60 : 643-653, 2014

8 Nagueh SF, "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" 29 : 277-314, 2016

9 Nagueh SF, "Recommendations for the evaluation of left ventricular diastolic function by echocardiography" 22 : 107-133, 2009

10 Bernardi M, "QT interval prolongation in liver cirrhosis: innocent bystander or serious threat?" 6 : 57-66, 2012

11 Bernardi M, "Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors" 27 : 28-34, 1998

12 Puthumana L, "Prolonged QTc interval and its relationship to autonomic cardiovascular reflexes in patients with cirrhosis" 35 : 733-738, 2001

13 Di Martino V, "Prognostic value of C-reactive protein levels in patients with cirrhosis" 21 : 753-760, 2015

14 Henriksen JH, "Increased circulating pro-brain natriuretic peptide (proBNP)and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease" 52 : 1511-1517, 2003

15 Ruíz-del-Árbol L, "Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine" 58 : 1732-1741, 2013

16 Carvalheiro F, "Diastolic dysfunction in liver cirrhosis: prognostic predictor in liver transplantation?" 48 : 128-131, 2016

17 Møller S, "Diastolic dysfunction in cirrhosis" 21 : 599-610, 2016

18 Falletta C, "Diastolic dysfunction diagnosed by tissue Doppler imaging in cirrhotic patients : prevalence and its possible relationship with clinical outcome" 26 : 830-834, 2015

19 Karagiannakis DS, "Diastolic cardiac dysfunction is a predictor of dismal prognosis in patients with liver cirrhosis" 8 : 588-594, 2014

20 Wiese S, "Cirrhotic cardiomyopathy : pathogenesis and clinical relevance" 11 : 177-186, 2014

21 Møller S, "Cirrhotic cardiomyopathy : a pathophysiological review of circulatory dysfunction in liver disease" 87 : 9-15, 2002

22 Ruiz-del-Árbol L, "Cirrhotic cardiomyopathy" 21 : 11502-11521, 2015

23 Fede G, "Cardiovascular dysfunction in patients with liver cirrhosis" 28 : 31-40, 2015

24 Pimenta J, "B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis" 30 : 1059-1066, 2010

25 Shi LY, "B-type natriuretic peptide and cirrhosis progression" 14 : 5188-5196, 2015

26 Timoh T, "A perspective on cirrhotic cardiomyopathy" 43 : 1649-1653, 2011