Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis

Behera, Manas Kumar; Swain, Surendra; Sahu, Manoj Kumar; Behera, Gaurav Kumar; Mishra, Debakanta; Narayan, Jimmy; Singh, Ayaskanta; Agarwal, S. K.; Mallick, Pradeep Kumar

doi:10.1155/2021/5592376

Cited by 5 publications

(9 citation statements)

References 37 publications

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“…This subgroup also demonstrated a great reduction in CO, which has been identified as a major driver of HRS development among patients with ascites [31,32]. Our results corroborate the findings of two other studies suggesting a link between worse diastolic dysfunction and increased risk for HRS [11,12]. By contrast, Nazar et al .…”

Section: Discussionsupporting

confidence: 90%

“…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: 90%

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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“…A recent research work by Behera et al ., investigated the effect of tissue Doppler imaging on the survival of patients with decompensated liver cirrhosis. According to their findings, E/e′ ratio higher than 10 was associated with worse survival in the multivariate models [24]. Another study by Merli et al .…”

Section: Discussionmentioning

confidence: 99%

HFA-PEFF score as an independent predictor of 2-year mortality in liver cirrhosis patients

Dimitroglou¹,

Tsartsalis²,

Vasilieva

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Cardiovascular complications of liver cirrhosis include high cardiac output heart failure with reduced afterload and diastolic dysfunction. Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology (HFA-PEFF) (values 0-6) is a diagnostic tool for heart failure. It is a cluster of echocardiographic and biochemical parameters. The purpose of this prospective study was to assess if HFA-PEFF score is associated with the severity of liver disease and to determine its prognostic significance in patients with cirrhosis. Methods Patients with cirrhosis without an acute event were enrolled. A comprehensive echocardiography study was conducted, brain natriuretic peptide and N-terminal-pro-B-type Natriuretic Peptide levels were measured and HFA-PEFF score was calculated. All patients were prospectively followed up after enrollment. The study end-point was defined as the composite of all-cause death. Results Seventy-two consecutive patients [median age 59 years (inter-quartile range: 52-65), 72.2% males, Model for Endstage Liver Disease (MELD) 12.9 (8.5-16.3)] were included. The 52.8% had a high HFA-PEFF score (5 or 6) and the 47.2% intermediate/low score (0-4). HFA-PEFF score was correlated with MELD score (rho = 0.566, P < 0.001), but not with age, SBP and heart rate. The median follow-up was 24.2 (9.5-38.8) months. The 1-and 2-year cumulative mortality was higher in patients with high HFA-PEFF compared to those with intermediate/low (log-rank P < 0.001 for both). The predicted 2-year probability of survival in high vs intermediate/low HFA-PEFF was found to be a prognostic factor of death even when adjusted for age, gender and MELD score [hazard ratio = 3.539 (1.134-11.046), P = 0.029]. Conclusion HFA-PEFF score is high among patients with liver cirrhosis, especially those with advanced liver disease. HFA-PEFF score is associated with survival even when adjusting for cirrhosis severity.

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“…Liang et al described the close link between chronic kidney disease progression and DD; together with systolic dysfunction it confers a higher mortality risk in patients with stages 3 to 5 14 . DD was shown as well to be associated with outcome in patients with decompensated cirrhosis; particularly an E/e′ ratio > 10 was independently associated with higher MELD score and mortality 28 . Regarding to SARS-Cov-2 infection, Skezely et al 4 documented that left ventricular DD was present in up to 16% of patients admitted with COVID-19 and, particularly, they found a significant association between mortality and elevated E/e′ ratio.…”

Section: Discussionmentioning

confidence: 93%

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

Carrión

Olmos

Luaces

et al. 2022

Sci Rep

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More than 91,000 fatalities due to Coronavirus Disease 2019 (COVID-19) have occurred in Spain. Several factors are associated with increased mortality in this disease, including cardiovascular risk factors (CVRF). However, information on the cardiac function of patients prior to the onset of COVID-19 is scarce and the potential impact it may have is uncertain. The aim of the EchoVID study was to describe the potential association between CVRF and cardiac function status prior to SARS-CoV-2 infection and in-hospital mortality. We studied clinical characteristics and cardiac function of patients admitted during the first wave of COVID-19. All patients had a transthoracic echocardiogram performed in the previous 12 months prior to diagnosis; conventional systolic and diastolic function parameters were analyzed. Logistic regression analysis was performed to identify predictors of in-hospital mortality. We included 296 individuals. Median age was higher in the group of patients who died (81.0 vs 76.1 years; p = 0.007). No significant differences were found in CVRF. Survivors were more frequently receiving anticoagulation therapy (52.9% vs 70.8%; p = 0.003). LVEF, although preserved on average in both groups, was significantly lower in the group of deceased patients (56.9% vs 61.1%; p = 0.017). Average E/e′ ratio was higher in the deceased group (11.1 vs 10.1; p = 0.049). Five variables were found to be independently associated with in-hospital mortality due to COVID-19: Age, male gender, LVEF, E/e′ ratio and anticoagulation therapy. A model including these variables had an area under the ROC curve of 0.756 (CI 0.669–0.843). The echocardiographic variables included in the model significantly improved the discriminative power, compared to a model including only demographic data. Left ventricular ejection fraction and E/e′ ratio prior to SARS-CoV-2 infection are two easily-obtained echocardiographic parameters that provide additional prognostic information over clinical factors when assessing patients admitted for SARS-CoV-2 infection.

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Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis

Cited by 5 publications

References 37 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

HFA-PEFF score as an independent predictor of 2-year mortality in liver cirrhosis patients

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19

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