Myocardial structural and functional changes in patients with liver cirrhosis awaiting liver transplantation: a comprehensive cardiovascular magnetic resonance and echocardiographic study

Abstract

Background: Cardiac dysfunction is increasingly recognized in patients with liver cirrhosis. Nevertheless, the presence or absence of structural alterations such as diffuse myocardial fibrosis remains unclear. We aimed to investigate myocardial structural changes in cirrhosis, and explore left ventricular (LV) structural and functional changes induced by liver transplantation. Methods: This study included 33 cirrhosis patients listed for transplantation and 20 healthy controls. Patients underwent speckle-tracking echocardiography and cardiovascular magnetic resonance (CMR) with extracellular volume fraction (ECV) quantification at baseline (n = 33) and 1 year after transplantation (n = 19).

Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease

“…Our results indicate significantly elevated GLS for ESLD patients, while LVEF values were unaltered. Data on GLS in cirrhotic patients with normal LVEF are limited and conflicting [ 17 , 18 , 19 , 20 ]. Mechelinck et al recently reported that both low and high GLSs occur in ELSD patients and are both negative prognostic factors [ 20 ].…”

“…Supporting this finding, we established a correlation of LV GLS with various liver-specific laboratory markers and MELD score. Kim et al observed normalization of elevated GLS in cirrhosis within one-year post-transplantation, showing the therapeutic value of LTx for systolic function [ 19 ].…”

“…With an E/A ratio >0.8, normal diastolic function can be stated according to the abovementioned guidelines. The E/e´ ratio also showed a significant increase; however, with a value of 9.42 ± 2.88, patients presented indeterminate results which do not allow clear interpretation [ 16 , 19 , 27 ]. Hence, diagnosis of DD in ESLD patients could not be validated through conventional parameters.…”

“…In consideration of previously reported potential changes in GLS post LTx by Kim et al [ 19 ], the lack of follow up cardiac examinations is a great limitation. These were not available for patients since they were transferred into ambulant care for annual checkups.…”

Analogies and differences between cirrhotic cardiomyopathy and hepatopulmonary syndrome

“…Finally, since patients with chronic liver disease have an increased free wall thickness of the right ventricle despite normal systolic pulmonary pressure, 39 echocardiographic strain rate parameters must also be recorded as well as the global longitudinal strain (composed of circumferential, longitudinal, radial, and transverse strain patterns) of the left ventricle that is more sensitive for systolic function assessment than the ejection fraction (Table 2). 40,41 Cardiac magnetic resonance, being validated to evaluate ventricular function, strain, and extracellular volume fraction quantification of cardiomyocytes (there is a cardiomyocytes volume expansion in CCM patients which normalizes 1‐year posttransplantation), can help detect subclinical changes 42,43 …”