High brain-natriuretic peptide level predicts cirrhotic cardiomyopathy in liver transplant patients

Saner, Fuat H.; Neumann, Till; Canbay, Ali; Treckmann, Juergen; Hartmann, Matthias; Goerlinger, Klaus; Bertram, Stefanie; Beckebaum, Susanne; Cicinnati, Vito R.; Paul, Andreas

doi:10.1111/j.1432-2277.2011.01219.x

Cited by 68 publications

(61 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that BNP was an independent predictor in multivariate Cox regression analysis, similar to previous results (Pimenta et al, 2010). BNP concentrations in patients with cirrhosis have been reported to be an independent predictor of medium-term (6-month) survival in hospitalized patients with decompensated cirrhosis, suggesting its utility in risk stratification of patients with advanced cirrhosis (Pimenta et al, 2010); this finder also was supported by the results of Saner et al (2011). This finding was not unexpected because, as mentioned above, increased BNP concentrations were found to be associated with the decompensation components of cirrhosis such as hepatic encephalopathy, esophageal varices, and ascites.…”

Section: Discussionsupporting

confidence: 90%

B-type natriuretic peptide and cirrhosis progression

Shi¹,

Jin²,

Lin³

et al. 2015

Genet. Mol. Res.

View full text Add to dashboard Cite

ABSTRACT. Brain natriuretic peptide (BNP) is used as a marker of cardiac dysfunction to predict heart failure mortality. The significance of the prognostic ability of BNP for liver cirrhosis remains unknown, although the levels of BNP seen in cirrhosis are high. We aimed to determine whether the BNP level is related to the stage of cirrhosis and could serve as a prognostic marker of cirrhosis (predict the 1-year all-cause mortality). We recruited 92 patients at different stages of cirrhosis and 81 controls matched by age and gender for this study. At admission, cardiac physical examination and BNP measurements were performed. Upon discharge, the 89 patients were followed up for 12 months. The median BNP levels of patients with cirrhosis were 167.0 pg/mL, which were significantly higher than those of the control group (167.0 vs 34.8 pg/mL, P = 0.001). Serum BNP levels were positively correlated with the Child score, the grade of esophageal varices, a history of spontaneous bacterial peritonitis, and the presence of ascites 5189 B-type natriuretic peptide and cirrhosis progression ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 5188-5196 (2015) and collateral circulation. BNP levels above the median were associated with an increased occurrence of death within 12 months of discharge (log rank P = 0.025), as determined by univariate and multivariate Cox regression analyses. Esophageal varices, large/medium volume ascites, and BNP levels were related to the clinical outcome (P = 0.034, 0.030, and 0.025, respectively). Together, these results suggested that serum BNP levels are significantly correlated with the stage of cirrhosis, suggesting that BNP levels might serve as a significant predictor for 1-year all-cause mortality.

show abstract

Section: Discussionsupporting

confidence: 90%

B-type natriuretic peptide and cirrhosis progression

Shi¹,

Jin²,

Lin³

et al. 2015

Genet. Mol. Res.

View full text Add to dashboard Cite

show abstract

“…B-type natriuretic peptide (BNP) is similarly cleaved from its pro-peptide and released from ventricular myocytes in response to ventricular wall stretch or myocardial ischaemia [56] , with the primary purpose of reducing cardiac hypertrophy and fibrosis [57] . Increased concentrations have been detected in cirrhosis, with levels correlating with the severity of liver disease, presence of diastolic dysfunction, myocardial hypertrophy and survival [46,49,58,59] . Preoperative levels of BNPs (BNP and NT-proBNP) are powerful independent predictors of cardiovascular events and mortality in patients undergoing non-cardiac surgery [60,61] , with further enhancement of this risk stratification seen with the additional measurement of postoperative levels [62,63] .…”

Section: Biomarkersmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

View full text Add to dashboard Cite

Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

show abstract

“…Cirrhotic cardiomyopathy results from multifactorial organic myocardial changes and is defined as systolic and diastolic cardiac dysfunction with co-existing electrocardiographic (ECG) abnormalities or abnormal serologic markers (brain natriuretic peptide [BNP], troponin 1, adrenomedullin) in patients with cirrhosis in the absence of cardiac diseases [1,2,4]. Patients with decompensated cirrhosis have been demonstrated to have elevated levels of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and left ventricle (LV) diastolic dysfunction [5]. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of any other known cardiac disease, in patients with liver cirrhosis [6].…”

mentioning

confidence: 99%

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Cichoż‐Lach¹,

Tomaszewski²,

Kowalik³

et al. 2015

Adv Clin Exp Med

View full text Add to dashboard Cite

Background. Liver cirrhosis is associated with functional abnormalities of the cardiovascular system with coexisting electrocardiographic (ECG) abnormalities. Objectives.The aim was to analyze ECG changes in patients with cirrhosis, to evaluate whether alcoholic etiology of cirrhosis and ascites has an impact on ECG changes. Material and Methods. The study involved 81 patients with previously untreated alcoholic cirrhosis (64 patients with ascites, classes B and C according to the Child-Pugh classification; and 17 without ascites, categorized as class A); 41 patients with previously untreated cirrhosis due to chronic hepatitis C (HCV -30 patients with ascites, classes B and C; and 11 without ascites, class A); 42 with alcoholic steatohepatitis and 46 with alcoholic steatosis. The control group consisted of 32 healthy volunteers. Twelve-lead ECG recordings were performed and selected parameters were measured. Results. Significantly longer QT and QTc intervals and lower QRS voltage were found in patients with alcoholic and HCV cirrhosis compared to the controls. Significantly lower QRS voltage was found in subjects with ascites than in those without ascites. Removal of ascites significantly increased QRS voltage. Conclusions. In cirrhosis, irrespective of etiology, ECG changes involved prolonged QT and QTc intervals and reduced QRS voltage. Prolonged QT and QTc intervals were not related to the severity of cirrhosis or to the presence of ascites. However, low QRS voltage was associated with the presence of ascites. Removal of ascites reverses low QRS voltage (Adv Clin Exp Med 2015, 24, 4, 615-622).

show abstract

High brain-natriuretic peptide level predicts cirrhotic cardiomyopathy in liver transplant patients

Cited by 68 publications

References 33 publications

B-type natriuretic peptide and cirrhosis progression

B-type natriuretic peptide and cirrhosis progression

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Contact Info

Product

Resources

About