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Al Atroush HH, Mohammed KH, Nasr FM, Al Desouky MI, Rabie MA. Cardiac dysfunction in patients with end-stage liver disease, prevalence, and impact on outcome: a comparative prospective cohort study. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Without firm diagnostic criteria, the exact prevalence of cirrhotic cardiomyopathy still remains unknown. Its estimation is rather a difficult task as the disease is generally latent and shows itself only when the patient is subjected to overt stress such as body position changes, exercise, drugs, hemorrhage, and surgery. In this study, we aim to assess cardiac dysfunction in patients with end-stage liver disease, study the correlation between cardiac dysfunction and Child-Pugh classification of patients with liver cell failure, and study the prevalence and impact of cardiac dysfunction on the clinical outcome of patients with child B and child C liver disease.
Results
Diastolic dysfunction was more prevalent among the patients’ group (p < 0.001). It was absent in 28 (70%) of control group, with grade 1 diastolic dysfunction in 12 (30%). Only one patient (2.5%) had no diastolic dysfunction, 21 patients (52.5%) had grade 1 diastolic dysfunction, 12 (30%) patients had grade 2 diastolic dysfunction, and 6 patients (15%) had grade 3 diastolic dysfunction. QTc interval was significantly prolonged in the patients’ group when compared to controls (p < 0.001). Echocardiographic parameters and QTc interval were comparable in child B and child C patients. All patients were followed up for a period of 3 months. Sixteen of 40 patients died in this period of time. Only child classification was found to significantly predict mortality, and patients with child C liver cirrhosis had worse survival when compared to patients with child B liver cirrhosis.
Conclusion
Most of the patients had cardiac dysfunction, mainly diastolic dysfunction (87.5%). The study detected the prevalence of diastolic dysfunction among end-stage liver disease when measuring E/É using TDI which proved to be more accurate than E/A ratio. Diastolic dysfunction is proved to be the most sensitive parameter in the diagnosis of cirrhotic cardiomyopathy, being the most parameter affected early. No correlation was found between cardiac dysfunction and the severity of hepatic illness, but the severity of hepatic illness affects the outcome rather than cardiac dysfunction.
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Cirrhotic Cardiomyopathy - A Veiled Threat. Cardiol Rev 2020; 30:80-89. [PMID: 33229904 DOI: 10.1097/crd.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with liver cirrhosis without pre-existing cardiac disease. According to the definition established by the World Congress of Gasteroenterology in 2005, the diagnosis of CCM includes criteria reflecting systolic dysfunction, impaired diastolic relaxation, and electrophysiological disturbances. Because of minimal or even absent clinical symptoms and/or echocardiographic signs at rest according to the 2005 criteria, CCM diagnosis is often missed or delayed in most clinically-stable cirrhotic patients. However, cardiac dysfunction progresses in time and contributes to the pathogenesis of hepatorenal syndrome and increased morbidity and mortality after liver transplantation, surgery or other invasive procedures in cirrhotic patients. Therefore, a comprehensive cardiovascular assessment using newer techniques for echocardiographic evaluation of systolic and diastolic function, allowing the diagnosis of CCM in the early stage of subclinical cardiovascular dysfunction, should be included in the screening process of liver transplant candidates and patients with cirrhosis in general. The present review aims to summarize the most important pathophysiological aspects of CCM, the usefulness of contemporary cardiovascular imaging techniques and parameters in the diagnosis of CCM, the current therapeutic options, and the importance of early diagnosis of cardiovascular impairment in cirrhotic patients.
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Right ventricular dysfunction in cirrhosis: A speckle-tracking echocardiography study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.818638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Yuan W, Lu HZ, Mei X, Zhang YY, Zhang ZG, Zou Y, Wang JF, Qian ZP, Guo HY. Cardiac health in patients with hepatitis B virus-related cirrhosis. Medicine (Baltimore) 2019; 98:e14961. [PMID: 30921198 PMCID: PMC6456085 DOI: 10.1097/md.0000000000014961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Not only alcoholic cirrhosis related to cardiac dysfunction, cirrhosis caused by nonalcoholic etiology including hepatitis B virus (HBV) infection also related to impaired cardiac health. The aims of present study were to perform a noninvasive evaluation of cardiac function and to evaluate exercise performance in HBV related cirrhotic patients without typical symptoms of cardiac disease.Seventy-nine HBV related cirrhotic patients and 103 matched subjects without a previous history of cardiac involvement were recruited. Clinical examination and cardiac health evaluation were performed. The incidence, risk factors of cardiac dysfunction and exercise tolerance were investigated.A correlation between QTc interval and model for end-stage liver disease score (R = 0.239, P = .018) was detected, however, the connection between QTc prolongation and the severity of liver disease was uncertain. Patients with HBV related cirrhosis had a tendency toward left ventricular wall thickening (P = .007). Forty-one patients (51.90%) were in accordance with the definition of cirrhotic cardiomyopathy, and a significant increase in the incidence of cardiac diastolic dysfunction (CDD) could be found with increasing Child-Pugh grade (P = .004). HBV related cirrhotic patients with CDD had a higher level of pro-brain natriuretic peptide (P = .025), international normalized ratio (P = .010) Child-Pugh score (P = .020), and a higher proportion of ascites (P < .001). The higher Child-Pugh score (odds ratio = 1.662, P = .010) was an independent diagnostic predictor of CDD. The cardiac depression and exercise tolerance also got worse with increasing Child-Pugh score (P < .001).Impaired cardiac health was common in HBV related cirrhotic patients. Cardiogenic factors must be carefully considered in the integral therapy of cirrhosis. Hepatology physicians should lay emphasis on exercise training in daily life.
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Affiliation(s)
- Wei Yuan
- Department of Liver Intensive Care Unit
| | - Hong-Zhou Lu
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xue Mei
- Department of Liver Intensive Care Unit
| | | | | | - Ying Zou
- Department of Liver Intensive Care Unit
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Farouk H, Al-Maimoony T, Nasr A, El-Serafy M, Ghany MA. Echocardiographic assessment of the left ventricular diastolic function in patients with non-alcoholic liver cirrhosis. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Hammami R, Boudabbous M, Jdidi J, Trabelsi F, Mroua F, Kallel R, Amouri A, Abid D, Tahri N, Abid L, Kammoun S. Cirrhotic cardiomyopathy: is there any correlation between the stage of cardiac impairment and the severity of liver disease? Libyan J Med 2017; 12:1283162. [PMID: 28245727 PMCID: PMC5345598 DOI: 10.1080/19932820.2017.1283162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/12/2017] [Indexed: 02/08/2023] Open
Abstract
Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in 'Child score' regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | | | - Jihen Jdidi
- Epidemiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fatma Trabelsi
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fakher Mroua
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Rahma Kallel
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Ali Amouri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Dorra Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Nabil Tahri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Leila Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Samir Kammoun
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
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A Case of Refractory Pulmonary Coccidioidomycosis Successfully Treated with Posaconazole Therapy. ACTA ACUST UNITED AC 2017. [PMID: 29938709 DOI: 10.14260/jemds/2017/1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coccidioidomycosis is an endemic fungal infection caused by the inhalation of the spores of Coccidioides species. Patients with underlying immunosuppressive illness can contract chronic or disseminated disease which requires prolonged systemic therapy. Pulmonary coccidioidomycosis remains as an illusory and abstruse disease, with increased prevalence that poses as a challenge for clinicians in developing an effective strategy for treatment. Here, we report successful treatment of a refractory case of chronic relapsing pulmonary coccidioidomycosis in a 50-year old woman with a thin-walled cavitary lung lesion who was ultimately treated with posaconazole.
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Shillcutt SK, Ringenberg KJ, Chacon MM, Brakke TR, Montzingo CR, Lyden ER, Schulte TE, Porter TR, Lisco SJ. Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events. J Cardiothorac Vasc Anesth 2016; 30:107-14. [DOI: 10.1053/j.jvca.2015.09.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Indexed: 02/07/2023]
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Dadhich S, Goswami A, Jain VK, Gahlot A, Kulamarva G, Bhargava N. Cardiac dysfunction in cirrhotic portal hypertension with or without ascites. Ann Gastroenterol 2014; 27:244-249. [PMID: 24974920 PMCID: PMC4073021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/03/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it correlates with severity of hepatic failure. But cardiac functions by conventional 2-dimensional (2-D) echocardiography has limitations. The aim of the study was to evaluate cardiac systolic and diastolic functions in liver cirrhosis patients with or without ascites by tissue Doppler imaging and conventional 2-D- echocardiography. METHODS A cross sectional case control study of sixty patients. Twenty subjects grouped as healthy controls, pre-ascitic cirrhosis and cirrhosis with ascites were enrolled. Cardiac evaluation was done by both conventional Doppler and tissue Doppler echocardiography. RESULTS Cirrhosis with portal hypertension is associated with increased heart rate, ejection fraction and mean peak systolic velocity, while mean arterial pressure is decreased. All cardiac chamber dilation occurs and is mostly seen in the left atrium. Ratio of early diastolic annular velocity to peak early diastolic annular wave velocity (E/e') was the most significant marker for diastolic dysfunction. E/e' ratio was 7.76±0.40, 12.55±1.73 and 11.4±1.19 in healthy controls, pre ascitic cirrhosis and ascitic cirrhosis respectively (P<0.0001). Overall Type I and II Left ventricular diastolic dysfunction was present in 70% cirrhotic patient with or without ascites, while there were no cases of Type III (Severe) diastolic dysfunction. CONCLUSION Left ventricular diastolic dysfunction is commonly associated with advancement of hepatic dysfunction while systolic function is maintained till advanced hepatic failure. Peak early diastolic wave velocity, deceleration time and E/e' ratio for left ventricular diastolic dysfunction are accurately assessed by pulsed tissue Doppler imaging.
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Affiliation(s)
- Sunil Dadhich
- Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur
| | - Amitava Goswami
- Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur,
Correspondence to: Amitava Goswami, Department of Gastroenterology, S.N.M.C. Jodhpur 352001, Rajasthan, India, Tel.: +087699 47345, e-mail:
| | - Vinit Kumar Jain
- Department of Cardiology (Vinit Kumar Jain), Dr Sampurnanand Medical College, Jodhpur
| | - Ankur Gahlot
- Department of Medicine (Ankur Gahlot), Dr Sampurnanand Medical College, Jodhpur
| | - Ganaraj Kulamarva
- Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur
| | - Narendra Bhargava
- Department of Gastroenterology (Sunil Dadhich, Amitava Goswami, Ganaraj Kulamarva, Narendra Bhargava), Dr Sampurnanand Medical College, Jodhpur
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