New Definition Criteria of Myocardial Dysfunction in Patients with Liver Cirrhosis: A Speckle Tracking and Tissue Doppler Imaging Study

Rimbaş, Roxana Cristina; Baldea, Sorina Mihăilă; Guerra, Ruxandra Drăgoi Galrinho Antunes; Visoiu, Ionela-Simona; Rimbaș, Mihai; Pop, Corina Silvia; Vinereanu, Dragoş

doi:10.1016/j.ultrasmedbio.2017.11.013

Cited by 33 publications

(62 citation statements)

References 54 publications

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“…(7,14,15) Although a limitation of GLS is that it varies with age and sex and is affected by LV loading conditions, the 2015 ASE guidelines for chamber quantification suggest GLS as an adjunct to assess LV systolic function in patients with normal LVEF. Data on strain imaging to detect CCM in patients with normal LVEF are limited and conflicting, with three studies showing normal longitudinal strain (16)(17)(18) and one multicenter study showing diminished longitudinal strain in one of two cohorts of patients with cirrhosis. (19) The latter study also showed that as liver disease advances, the GLS increases and correlates with impaired transplant-free survival.…”

Section: Ccm In the Spectrum Of Hfmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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Cirrhotic cardiomyopathy (CCM) is cardiac dysfunction in patients with end‐stage liver disease in the absence of prior heart disease. First defined in 2005 during the World Congress of Gastroenterology, CCM criteria consisted of echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Significant advancements in cardiovascular imaging over the past 14 years, including the integration of myocardial deformation imaging into routine clinical practice to identify subclinical cardiovascular dysfunction, have rendered the 2005 CCM criteria obsolete. Therefore, new criteria based on contemporary cardiovascular imaging parameters are needed. In this guidance document, assembled by a group of multidisciplinary experts in the field, new core criteria based on contemporary cardiovascular imaging parameters are proposed for the assessment of CCM. This document provides a critical assessment of the diagnosis of CCM and ongoing assessment aimed at improving clinical outcomes, particularly surrounding liver transplantation. Key points and practice‐based recommendations for the diagnosis of CCM are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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Section: Ccm In the Spectrum Of Hfmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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“…Second, contrary to the authors' suggestion that the E/E′ ratio can accurately estimate left ventricular filling pressure (LVFP), a recent meta-analysis reported insufficient evidence to support it as a reliable parameter for the quantification of LVFP in patients with preserved ejection fraction. (3) In our experience, the ratio of isovolumetric relaxation time/time from onset of E wave to onset of E′ wave predicts mortality better than the E/E′ ratio in the DD subgroup because it is independent of loading conditions. (3) Third, patients with LC have different grades of DD not included in the current definition of cirrhotic cardiomyopathy (CCM).…”

Section: To the Editormentioning

confidence: 82%

“…(3) Third, patients with LC have different grades of DD not included in the current definition of cirrhotic cardiomyopathy (CCM). We consider it mandatory to correctly assess DD grades from mild to severe because the prognostic role of each grade should be judged separately (1,3) . Moreover, there are many tissue-Doppler and speckle-tracking echocardiographic parameters available for the estimation of ventricular function that are not yet included in the CCM definition, and there is evidence that stress echocardiography might be an important tool for CCM diagnosis because cardiac dysfunction becomes more evident in stressful conditions.…”

Section: To the Editormentioning

confidence: 99%

“…Moreover, there are many tissue-Doppler and speckle-tracking echocardiographic parameters available for the estimation of ventricular function that are not yet included in the CCM definition, and there is evidence that stress echocardiography might be an important tool for CCM diagnosis because cardiac dysfunction becomes more evident in stressful conditions. (3) In conclusion, the actual definition of CCM should be changed. DD grading should be based on a stepby-step multiparameter approach, not a simplified one.…”

Section: To the Editormentioning

confidence: 99%

“…It is relevant to outline that all randomized and open studies assessing the efficacy of baclofen in patients with AUD and ALD clearly showed that this favors the maintaining of abstinence from alcohol even at a low dose (30 mg/day), a result fully confirmed by a recent randomized trial. (3) Second, when discussing about the approach to patients with an advanced (end-stage) liver disease, which was the matter dealt with in our review, it cannot be under-rated that the approved medications are contraindicated in this context, because of the risk of either liver toxicity (naltrexone and disulfiram) or hepatic encephalopathy (acamprosate). Thus, topiramate and baclofen only remain even though they have to be used off-label.…”

mentioning

confidence: 99%

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