Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review

Abstract

BACKGROUND Liver cirrhosis is a chronic hepatic disease which is associated with cardiovascular abnormalities. Hyperdynamic circulation in liver cirrhosis causes functional and structural cardiac alterations. The prevalence of left ventricle diastolic dysfunction (LVDD) in cirrhotic patients ranges from 25.7% to as high as 81.4% as reported in different studies. In several studies the severity of diastolic dysfunction (DD) correlated with a degree of liver failure and the rate of dysfunction was higher in patients with decompensated cirrhosis compared with compensated. Future directions of comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients. AIM To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing literature. METHODS Through January and February of 2019 at Vilnius University we conducted a systematic review of the global existing literature on the prevalence of left ventricle diastolic dysfunction in patients with liver cirrhosis. We searched for articles in PubMed, Medline and Web of science databases. Articles were selected by using adequate inclusion and exclusion criteria. Our interest was the outcome of likely correlation between the severity of cirrhosis [evaluated by Child-Pugh classes, Model For End-Stage Liver Disease (MELD) scores] and left ventricle diastolic dysfunction [classified according to American Society of Echocardiography (ASE) guidelines (2009, 2016)], as well as relative risk of dysfunction in cirrhotic patients. Subgroup analyses were performed to evaluate the ratio and grades of left ventricle diastolic dysfunction with respect to cirrhosis severity. RESULTS A total of 1149 articles and abstracts met the initial search criteria. Sixteen articles which met the predefined eligibility criteria were included in the final analysis. Overall, 1067 patients (out of them 723 men) with liver cirrhosis were evaluated for left ventricle diastolic dysfunction. In our systemic analysis we have found that 51.2% of cirrhotic patients had left ventricle diastolic dysfunction diagnosed and the grade 1 was the most prevalent (59.2%, P < 0.001) among them, the grade 3 had been rarely diagnosed - only 5.1%. The data about the prevalence of diastolic dysfunction in cirrhotic patients depending on Child-Pugh Classes was available from 5 studies (365 patients overall) and only in 1 research diastolic dysfunction was found being associated with severity of liver cirrhosis ( P < 0.005). We established that diastolic dysfunction was diagnosed in 44.6% of Child-Pugh A class patients, in 62% of Child B class and in 63.3% of Child C patients ( P = 0.028). The proportion of patients with higher diastolic dysfunction grades increases in more severe cirrhosis presentation ( P ...

Cardiac Changes in Cirrhotic Patients

“…This study reveals that there is positive correlation between severity of liver cirrhosis and cardiac changes. This result agrees with that of Salari et al [20] and Stundiene et al [24], on the other hand these findings disagree with that of Merli et al [11], and with the publication of Silvestre et al [12].This disagreement could be due to the small number of the studied population in their studies, the prevalence of cirrhotic cardiomyopathy varies widely because of the lack of a clear definition, the variability of the tools used to assess this entity, and finally ,the variability of inclusion criteria [12].…”

Elafibranor improves diet-induced nonalcoholic steatohepatitis associated with heart failure with preserved ejection fraction in Golden Syrian hamsters

“…Although we did not measure blood pressure in the present study, the Golden Syrian hamster strain is not spontaneously hypertensive [48] and free choice diet resulted in bridging fibrosis, but not cirrhosis. This would also exclude a contribution of hypertension [49] or portal hypertension [50] in promoting left ventricular dysfunction. Instead, the significant effects of both the free choice and elafibranor on hepatic gene expression and NAFLD activity score would suggest a prominent role of the liver.…”

Zirrhotische Kardiomyopathie

“…Bei Patienten mit CCM ist die diastolische Funktion oftmals stärker beeinträchtigt als die systolische und es wird vermutet, dass bis zu 50 % aller Patienten mit Leberzirrhose eine diastolische Dysfunktion aufweisen [8,12,13].…”