Cardiac Index and Left Ventricular Function Changes in Cirrhosis Measured by Radionuclide Angiocardiography

Abstract

Radionuclide angiocardiography (RNAC) was used to measure cardiac function in 134 patients with cirrhosis. In 14 patients, with a cardiac outputs range of 4–20 liters/min, RNAC correlated significantly (r = 0.82) with cardiac output as measured by thermodilution. Studies of reproducibility in 72 patients showed that 30 % of the patients had a cardiac index (CI) which varied by 5 % or less on repeated study, and in 80 % in of the patients the CI varied by 15 % or less: the variability was similar for all ranges of CI. The mean ( ± SD) CI for the 134 patients was 4.4 ± 1.2 liters/min/m² (range 2.2–8.3), with 31% of patients falling into a hyperdynamic range ( > 4.75 liters/min/m²) as defined by 2 SD above the normal CI. CI showed a significant (p < 0.001) positive correlation to end-diastolic volume index (EDVI), ejection fraction (EF), and heart rate. These findings indicate good myocardial function in these patients at rest, with markedly augmented stroke volume. A significant (p < 0.05) correlation was shown between CI and the Child classification, but not to other indices of hepatic function. In conclusion, RNAC offers a reproducible, clinically applicable method for measuring cardiac function in cirrhosis. The high resting CI of cirrhosis results from an increase in EDVI, EF and heart rate. Further studies are required to document how these parameters change with stress or pharmacologic manipulation.

Elevated circulating cardiac troponin I in patients with cirrhosis

“…4 Most cardiomyopathies have been observed in alcoholic cirrhosis but nonalcoholic cirrhosis may be also associated with latent cardiomyopathy. 4,25 In the present study, elevated cardiac troponin I concentrations were mainly observed in patients with alcoholic cirrhosis because only one patient had another cause of cirrhosis. Thus, asymptomatic alcoholic cardiomyopathy might play a role in the increased troponin I.…”