Left Ventricular Dysfunction In Patients With Liver Disease

International Journal of Medical Science

© 2021 by SSRG - IJMS Journal

Volume 8 Issue 10

Year of Publication : 2021

Authors : Kamal Dwebeh, Abdullah Cheikh Ibrahim, Maher Madi

10.14445/23939117/IJMS-V8I10P101

How to Cite?

Kamal Dwebeh, Abdullah Cheikh Ibrahim, Maher Madi, "Left Ventricular Dysfunction In Patients With Liver Disease," SSRG International Journal of Medical Science, vol. 8,  no. 10, pp. 1-5, 2021. Crossref, https://doi.org/10.14445/23939117/IJMS-V8I10P101

Abstract:

A. Background: Both liver and heart diseases are considered a serious problem in the health system and a major reason for the deterioration of the quality of life and its short expected duration. Therefore, it is important to study the hepato-cardiac interactions.

B. Aim & Objective: studying the effects of liver diseases on left ventricle (LV) systolic, diastolic & electrophysiological functions.

C. Material & Methods: A total of 63 cases of diagnosed liver disease patients (22 without cirrhosis and 41 with cirrhosis) with 63 age sex-matched healthy control subjects were included in this study. Both those with liver disease and healthy subjects underwent an electrocardiogram and 2D Echocardiography.

D. Results: QTc interval in liver disease patients was longer than controls and abnormally prolonged in cirrhotic patients. The systolic function of LV in liver disease patients was mostly normal but increased in cirrhotic patients with a statistical significance when compared to non-cirrhotic patients and the control group. Diastolic dysfunction was noticed in cirrhotic and non-cirrhotic patients. In cirrhosis, there were a statistically significant increase in IVRT [ 92.36±12.2 ms] VS.[ 73.7±10.2 ms] in the control group (P<0.05). In noncirrhotic patients, there was a statistically significant increase in IVRT [88.77±13.1] VS. [73.7±10.2] in the control group (P<0.05). We noticed a statistically significant increase in Myocardial Performance Index(MPI) in cirrhotic and non-cirrhotic patients [0.43±0.1 and 0.39±0.05 respectively] VS. [0.33±0.04] in the control group (P<0.05).

E. Conclusion: In patients with liver disease, QTc interval was longer, and in addition to compromised LV diastolic function, MPI was also increased, which reflects both systolic and diastolic LV dysfunction.

Keywords:

liver disease; cirrhosis; Left Ventricular function; Doppler Echocardiography.

References:

[1] Wang F, So KF, Xiao J, Wang H. Organ-organ communication, The liver's perspective. Theranostics 11(7) (2021) 3317-3330. doi:10.7150/thno.55795
[2] Yaxing Zhang, Xian-Ming Fang., Hepatocardiac or Cardiohepatic Interaction: From Traditional Chinese Medicine to Western Medicine, Evidence-Based Complementary and Alternative Medicine, Article ID 6655335, (2021) 14 . https://doi.org/10.1155/2021/6655335
[3] Asrani, S. K., Devarbhavi, H., Eaton, J., & Kamath, P. S., The burden of liver diseases in the world. Journal of Hepatology, 70(1) (2019) 151–171. https://doi.org/10.1016/j.jhep.2018.09.014
[4] Møller, S., & Bernardi, M., Interactions of the heart and the liver. European Heart Journal, 34(36) (2013) 2804–2811. https://doi.org/10.1093/eurheartj/eht246
[5] Fouad, Y. M., & Yehia, R., Hepato-cardiac disorders. World Journal of Hepatology, 6(1) (2014) 41. https://doi.org/10.4254/wjh.v6.i1.41
[6] Zipes, D. P., Libby, P., Braunwald, E., Bonow, R. O., Mann, D. L., & Tomaselli, G. F., Braunwald’s Heart Disease (11th edition). Elsevier Gezondheidszorg. (2019) 125.
[7] Sherif N, Otto S, Christopher A, Benjamin B, Hisham D, Thor E, Frank F, Thierry G, Allan L, Patrizio L, Paolo M, Jae Oh, Bogdan P, Alan W, 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. Journal of the American Society of Echocardiography, 29(4).
[8] Shingu Y, Amorim P, Nguyen TD, Mohr FW, Schwarzer M, Doenst T. Myocardial performance (Tei) index is normal in diastolic and systolic heart failure induced by pressure overload in rats. Eur J
Echocardiogr, 11(10) (2010) 829-33. doi: 10.1093/eject card/jeq077. Epub 2010 Jun 18. PMID: 20562113.
[9] Stahl, E. P., Dhindsa, D. S., Lee, S. K., Sandesara, P. B., Chalasani, N. P., & Sperling, L. S., Nonalcoholic Fatty Liver Disease and the Heart. Journal of the American College of Cardiology, 73(8) (2019) 948–963. https://doi.org/10.1016/j.jacc.2018.11.050
[10] Gaafar, A. E., Abd El-Aal, A., Alboraie, M., Hassan, H. M., ElTahan, A., AbdelRahman, Y., Wifi, M. N., Omran, D., Mansour, S. A., Hassan, W. M., Ismail, M., & el Kassas, M., Prevalence of prolonged QT interval in patients with HCV-related chronic liver disease. The Egyptian Heart Journal, 71(1) (2019). https://doi.org/10.1186/s43044-019-0016-0
[11] Adlan, A. M., Panoulas, V. F., Smith, J. P., Fisher, J. P., &Kitas, G. D., Association Between Corrected QT Interval and Inflammatory Cytokines in Rheumatoid Arthritis. The Journal of Rheumatology, 42(3) (2015) 421–428. https://doi.org/10.3899/jrheum.140861
[12] Zambruni, A., Trevisani, F., Caraceni, P., & Bernardi, M., Cardiac electrophysiological abnormalities in patients with cirrhosis. Journal of Hepatology, 44(5) (2006) 994–1002. https://doi.org/10.1016/j.jhep.2005.10.034
[13] al Hamoudi, W., & Lee, S. S., Cirrhotic Cardiomyopathy. Annals of Hepatology, 5(3) (2006) 132–139. https://doi.org/10.1016/s1665-2681(19)31996-9
[14] Zardi, E. M., Abbate, A., Zardi, D. M., Dobrina, A., Margiotta, D., van Tassel, B. W., Afeltra, A., &Sanyal, A. J., Cirrhotic Cardiomyopathy. Journal of the American College of Cardiology, 56(7) (2010) 539–549. https://doi.org/10.1016/j.jacc.2009.12.075
[15] Bernardi, M., Maggioli, C., Dibra, V., &Zaccherini, G., QT interval prolongation in liver cirrhosis, innocent bystander or serious threat? Expert Review of Gastroenterology & Hepatology, 6(1) (2012) 57–66. https://doi.org/10.1586/egh.11.86
[16] Pudil, R., Pelouch, R., Praus, R., Vašatová, M., &Hůlek, P., Heart failure in patients with liver cirrhosis. Cor et Vasa, 55(4) (2013) e391–e396. https://doi.org/10.1016/j.crvasa.2013.06.002
[17] Fede G, Privitera G, Tomaselli T, Spadaro L, Porrello F. Cardiovascular dysfunction in patients with liver cirrhosis. Ann Gastroenterol. 28(1) (2015) 31-40. PMID: 25608575; PMCID: PMC4290002.
[18] Møller, S., &Bendtsen, F., The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver International, 38(4) (2018) 570–580. https://doi.org/10.1111/liv.13589
[19] Moller, S., &Henriksen, J. H., Cardiovascular complications of cirrhosis. Gut, 57(2) (2008) 268–278. https://doi.org/10.1136/gut.2006.112177
[20] Grace, J. A., Klein, S., Herath, C. B., Granzow, M., Schierwagen, R., Masing, N., Walther, T., Sauerbruch, T., Burrell, L. M., Angus, P. W., &Trebicka, J., Activation of the Mas Receptor by Angiotensin-(1–7) in the Renin-Angiotensin System Mediates Mesenteric Vasodilatation in Cirrhosis. Gastroenterology, 145(4) (2013) 874–884.e5.https://doi.org/10.1053/j.gastro.2013.06.036
[21] Møller, S., Wiese, S., Halgreen, H., & Hove, J. D., Diastolic dysfunction in cirrhosis. Heart Failure Reviews, 21(5) (2016) 599–610. https://doi.org/10.1007/s10741 -016-9552-9
[22] Merli, M., Calicchia, A., Ruffa, A., Pellicori, P., Riggio, O., Giusto, M., Gaudio, C., &Torromeo, C., Cardiac dysfunction in cirrhosis is not associated with the severity of the liver disease. European Journal of Internal Medicine, 24(2) (2013) 172–176. https://doi.org/10.1016/j.ejim.2012.08.007