Purpose
The blunted ventricular systolic and diastolic contractile response to physical and pharmacological stress in patients with advanced cirrhosis is termed cirrhotic cardiomyopathy (CCM).
The pathogenesis of cardiac dysfunction in cirrhosis is not well understood.
A latent cardiac dysfunction could be involved to morbidity and mortality,
particularly after liver transplantation or transjugular intrahepatic portosystemic shunt (TIPS).
The aim of this study was to evaluate the effects of hemodynamic overload on CCM after TIPS placement.
Methods and Materials
Twenty-one cirrhotic patients without known cardiovascular pathologies were enrolled: 15 patients with advanced cirrhosis and serum creatinine > 1.5 mg/ml (MELD 14±4) candidates to TIPS for refractory ascites (TIPS group) and 6 patients with gdfcompensated cirrhosis (MELD 7±1.2) (control group) (TABLE 1).
Cardiac Magnetic Resonance (MR) and Transthoracic Echocardiography (TTE) were performed in baseline conditions in all patients and one month later after TIPS placement (Fig.
1-2).
All MR images were acquired with a 1.5 T scanner (GE Signa Excite).
Multiple Short Axis (SA) cine...
Results
In baseline conditions,
there were not significant differences in cardiac index (CI) [p=0.56],
stroke volume (SV) [p=0.44],
end diastolic volume (EDV) [p=0.42],
EF [p=0.11],
E/A ratio [p=0.62] and deceleration time (DT) [p=0.45] between TIPS group and control group (TABLE 2).
No patient showed late gadolinium enhancement of the myocardium.
Diastolic dysfunction was detected both in advanced cirrhosis (baseline condition) and in compensated cirrhosis (control group).
In TIPS group,
5 patients had E/A < 1 and 8 patients had prolonged (>200 ms) DT.
In control group...
Conclusion
The hemodynamic overload after TIPS placement causes an increase of CI and SV.
Unexpectedly,
in patients with advanced cirrhosis the increased volume load shunted to the heart doesn’t seem negatively affects the systolic and diastolic function.
References
1) Moller S.
and Henriksen J.H.
Cirrhotic cardiomyopathy.
Journal of Hepatology 2010 Vol.
53 179-190
2) Zardi E.
M.
et al.
Cirrhotic cardiomyopathy.
JACC vol.
56,
No.
7,
2010
3) Lossnitzer D.
et al.
Myocardial late gadolinium enhancement cardiovascular magnetic resonance in patients with cirrhosis.
Journal of Cardiovascular Magnetic Resonance 2010,
12:47
4) Cardenas A,
Gines P: Portal hypertension.
Curr Opin Gastroenterol 2009,
25(3):195-201.
5) Menon KV,
Kamath PS: Regional and systemic hemodynamic disturbances in cirrhosis.
Clin Liver Dis 2001,
5(3):617-627,
viii.
6) Moller S,...
