1021 Cardiac Diastolic Dysfunction Is Associated With Impaired Natriuresis in Patients With Decompensated Cirrhosis and Ascites

Cholongitas, Evangelos; Goulis, John; Ekklisiarchos, D.; Birtsou, Charis; Nakouti, Theodora; Chalevas, Parthenis; Paulou, D.; Ioannidou, Maria; Akriviadis, Evangelos

doi:10.1016/s0168-8278(13)61022-3

Cited by 4 publications

(12 citation statements)

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“…We demonstrated a high prevalence of LVDD (66%) in a large cohort of patients with cirrhosis and ascites. Interestingly, 12.7% of patients in our study were diagnosed with grade 3 LVDD, which corroborates the results of two previous studies [9,19] evaluating patients with ascites (both refractory and nonrefractory). Yet, all other studies but one [10] failed to demonstrate grade 3 LVDD in mixed cohorts of patients with and without ascites.…”

Section: Discussionsupporting

confidence: 91%

“…We are aware that the main limitation of our study is that LVDD was defined by the 2009 and not newer ASE criteria [4] taking into account that our study was designed and initiated in 2014. Yet, it must be noted that the 2009 criteria are the most commonly employed criteria for LVDD definition in patients with cirrhosis [8][9][10][11][12]18,[35][36][37][38] enabling the comparison of the results of different studies. Another potential limitation is that left atrial volume was not implemented for the diagnosis of LVDD.…”

Section: Discussionmentioning

confidence: 99%

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Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Kalambokis,

Christaki,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Left ventricular diastolic dysfunction (LVDD) is the predominant cardiac abnormality in cirrhosis. We investigated the association of LVDD with systemic inflammation and its impact on renal function, occurrence of hepatorenal syndrome (HRS) and survival in patients with cirrhosis and ascites. We prospectively enrolled 215 patients with cirrhosis and ascites. We evaluated the diagnosis and grading of LVDD by Doppler echocardiography, inflammatory markers, systemic hemodynamics, vasoactive factors, radioisotope-assessed renal function and blood flow, HRS development and liver-related mortality. LVDD was diagnosed in 142 (66%) patients [grade 2/3: n = 61 (43%)]. Serum lipopolysaccharide-binding protein (LBP), plasma renin activity (PRA) and glomerular filtration rate (GFR) were independently associated with the presence of grade 2/3 LVDD and the severity of diastolic dysfunction. Serum tumor necrosis factor-α, cardiac output and plasma noradrenaline were also independently associated with the presence of grade 2/3 LVDD. The diastolic function marker E/e′ was strongly correlated with serum LBP (r = 0.731; P < 0.001), PRA (r = 0.714; P < 0.001) and GFR (r = −0.609; P < 0.001) among patients with LVDD. The 5-year risk of HRS development and death was significantly higher in patients with grade 2/3 LVDD compared to those with grade 1 (35.5 vs. 14.4%; P = 0.01 and 53.3 vs. 28.2%; P = 0.03, respectively). The occurrence and severity of LVDD in patients with cirrhosis and ascites is closely related to inflammatory activity. Advanced LVDD is associated with baseline circulatory and renal dysfunction, favoring HRS development, and increased mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Kalambokis,

Christaki,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“…The prevalence of diastolic dysfunction in cirrhosis may be up to 40%‐50% depending on the population . The presence of diastolic dysfunction seems related to severity of disease, development of complications and mortality . Moreover, diastolic dysfunction predicts the course after TIPS insertion …”

Section: The Hyperdynamic Circulation and The Heartmentioning

confidence: 99%

The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis

Möller

Bendtsen

2018

Liver International

155

120

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“…Current data suggest the diastolic dysfunction associated with CCM has the most important adverse clinical implications. It is related to liver disease severity, ascites and HRS, 55,56 post‐operative, post‐TIPS complications 57‐59 and mortality 60 …”

Section: Clinical Diagnostic Criteriamentioning

confidence: 99%

Review article: comprehensive analysis of cirrhotic cardiomyopathy

Chahal

Liu

Shamatutu

et al. 2021

Aliment Pharmacol Ther

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SummaryBackgroundPatients with cirrhosis are at risk of developing cirrhotic cardiomyopathy. This syndrome is unique to cirrhosis and is generally defined as subnormal cardiac function in the absence of prior heart disease. There is no systematic or comprehensive review of cirrhotic cardiomyopathy to date.AimsTo comprehensively review the literature on the definition, pathogenic mechanisms, diagnostic criteria, prevalence, management and influence on liver transplantation including reversibility of cirrhotic cardiomyopathy.MethodsElectronic searches of the EMBASE, MEDLINE, EBM Reviews—Cochrane Central Register of Controlled Trials, EBM Reviews—Cochrane Database of Systematic Reviews and Google Scholar databases were conducted. MeSH terms focused on cirrhosis, cardiomyopathy, medication classes and epidemiology. Literature up to August 2020 was reviewed.ResultsNew diagnostic criteria for the definition of cirrhotic cardiomyopathy have recently been published, consisting of systolic and diastolic dysfunction parameters as assessed by echocardiographic methods. The roles of electrocardiographic disturbances and biomarkers in the definition criteria remain unclear. Pathogenic mechanisms underlying cirrhotic cardiomyopathy are likely related to the inflammatory phenotype of cirrhosis. Prevalence rates of 26%‐81% in cirrhotic patients are reported. Several medical therapies have been proposed, but none with clear evidence of efficacy. The presence of cirrhotic cardiomyopathy complicates the liver transplantation process with a higher risk of adverse cardiovascular events post‐transplant. Complete reversibility of the syndrome after transplantation remains controversial but most studies suggest that it does not occur at least within the first post‐operative year.ConclusionsCirrhotic cardiomyopathy is a clinically relevant syndrome that affects morbidity and mortality in patients with cirrhosis.

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1021 Cardiac Diastolic Dysfunction Is Associated With Impaired Natriuresis in Patients With Decompensated Cirrhosis and Ascites

Cited by 4 publications

References 0 publications

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis

Review article: comprehensive analysis of cirrhotic cardiomyopathy

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