Right ventricular dysfunction in cirrhosis: A speckle-tracking echocardiography study

Deniz Ogutmen Koc; Tayfun Şahin; Sila Oksuz; Hulya Cebe; Ali Erkan Duman; Yasemin Gökden; Ugur Korkmaz; Tanyeli Güneyligil

doi:10.28982/josam.818638

Authors

Deniz Ogutmen Koc https://orcid.org/0000-0003-2738-625X
Tayfun Şahin https://orcid.org/0000-0002-0851-2946
Sila Oksuz https://orcid.org/0000-0003-4721-0585
Hulya Cebe https://orcid.org/0000-0003-1954-406X
Ali Erkan Duman https://orcid.org/0000-0002-7093-2503
Yasemin Gökden https://orcid.org/0000-0001-6767-3072
Ugur Korkmaz https://orcid.org/0000-0002-1103-5343
Tanyeli Güneyligil https://orcid.org/0000-0002-4191-1244

DOI:

https://doi.org/10.28982/josam.818638

Keywords:

Cirrhotic cardiomyopathy, right ventricular dysfunction, echocardiography, speckle-tracking analysis

Abstract

Aim: The majority of studies on cardiac dysfunction in patients with cirrhosis are associated with left ventricular (LV) myocardial dysfunction, with fewer studies on right ventricular (RV) function. The aims of this study were to evaluate biventricular function, particularly RV function, in patients with cirrhosis and investigate its relationship with disease severity. Methods: We included 50 hospitalized and ambulatory patients with cirrhosis and 33 healthy controls. Echocardiographic evaluation was performed with speckle-tracking analysis. Liver disease was graded according to Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Results: In our study, the most prevalent etiology of cirrhosis was viral hepatitis (60%), followed by non-alcoholic fatty liver disease (24%). RV-global longitudinal strain (GLS) and LV ejection fraction (EF) values were lower in patients with cirrhosis compared to the control group (both, P=0.001). LVEF was <55% in 19 (38%) patients. Decreases in RV-GLS and LVEF values were more common in patients with ascites (both, P=0.001). However, measurements of RV-GLS and LVEF did not distinguish the degree of severity of liver disease on the basis of Child-Pugh and MELD scores. LV-GLS values between patients with cirrhosis and the control group were similar (P=0.896). Conclusions: This study showed that RV function was impaired in patients with cirrhosis and more commonly, in patients with ascites. However, values of RV-GLS did not distinguish the degree of severity of liver disease. In addition, the LVEF was low and LV-GLS was normal in patients with cirrhosis.

Downloads

Download data is not yet available.

References

Møller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53(1):179-90. doi: 10.1016/j.jhep.2010.02.023

Wong F. Cirrhotic cardiomyopathy. Hepatol Int. 2009;3(1):294-304. doi: 10.1007/s12072-008-9109-7

Lee RF, Glenn TK, Lee SS. Cardiac dysfunction in cirrhosis. Best Pract Res Clin Gastroenterol. 2007;21(1):125-40. doi: 10.1016/j.bpg.2006.06.003

Izzy M, VanWagner LB, Lin G, Altieri M, Findlay JY, Oh JK, et al. Redefining Cirrhotic Cardiomyopathy for the Modern Era. Hepatology. 2020 Jan;71(1):334-45. doi: 10.1002/hep.30875

Wong F, Girgrah N, Graba J, Allidina Y, Liu P, Blendis L. The cardiac response to exercise in cirrhosis.Gut. 2001 Aug;49(2):268-75. doi: 10.1136/gut.49.2.268

Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, et al. Systolic and diastolic dysfunction in cirrhosis: a tissue-Doppler and speckle tracking echocardiography study. Liver Int. 2013 Sep;33(8):1158-65. doi: 10.1111/liv.12187

Rigolin VH, Robiolio PA, Wilson JS, Harrison JK, Bashore TM. The forgotten chamber: The importance of the right ventricle. Cathet Cardiovasc Diagn. 1995;35(1):18-28. doi: 10.1002/ccd.1810350105

Chen Y, Chan AC, Chan SC, Chok SH, Sharr W, Fung J, et al. A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation.J Cardiol. 2016 Feb;67(2):140-6. doi: 10.1016/j.jjcc.2015.08.001

Marmor A, Geltman EM, Biello DR, Sobel BE, Siegel BA, Roberts R. Functional response of the right ventricle to myocardial infarction: dependence of the site of left ventricular infarction. Circulation. 1981;64(5):1005-11. doi: 10.1161/01.cir.64.5.1005

Yiu KH, Schouffoer AA, Marsan NA, Ninaber MK, Stolk J, Vlieland TV, et al. Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: relationship to functional capacity and ventricular arrhythmias. Arthritis Rheum 2011;63:3969–78. doi: 10.1111/ajt.12385

Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646-9.

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464-70. doi: 10.1053/jhep.2001.22172

Merli M, Calicchia A, Ruffa A, Pellicori P, Riggio O, Giusto M, et al. Cardiac dysfunction in cirrhosis is not associated with the severity of liver disease. European Journal of Internal Medicine. 2013;24:172–6. doi: 10.1016/j.ejim.2012.08.007

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:233-70.

Foley TA, Mankad SV, Anavekar NS, Bonnichsen CR, Morris MF, Miller TD, et al. Measuring Left Ventricular Ejection Fraction - Techniques and Potential Pitfalls. European Cardiology. 2012;8(2):108-14. doi:10.15420/ecr.2012.8.2.108

Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015 Feb;28(2):183-93. doi: 10.1016/j.echo.2014.11.003

Kia L, Shah SJ, Wang E, Sharma D, Selvaraj S, Medina C, et al. Role of pretransplant echocardiographic evaluation in predicting outcomes following liver transplantation. Am J Transplant. 2013 Sep;13(9):2395-401. doi: 10.1111/ajt.12385

Møller S, Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart. 2002 Jan;87(1):9-15. doi: 10.1136/heart.87.1.9

Zhang Kun, Braun A, von Koeckritz F, Schmuck RB, Teegen EM, Cuspidi C, et al. Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View. J Clin Med. 2019 Sep;8(9):1285. doi: 10.3390/jcm8091285

Bansal M, Sengupta PP. Longitudinal and Circumferential Strain in Patients with Regional LV Dysfunction. Curr Cardiol Rep. 2013 Mar;15(3):339. doi: 10.1007/s11886-012-0339-x

Zakia ER, Baha El Deenb NM. Relation of right ventricular dysfunction to the severity of hepatic cirrhosis by different echo modalities using speckle-tracking echocardiography. Al-Azhar Assiut Med J. 2017;15:7–14. doi: 10.4103/1687-1693.213588

Nazar A, Guevara M, Sitges M, et al. LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction. J Hepatol. 2013;58:51–7.

Grose RD, Nolan J, Dillon JF, Errington M, Hannan WJ, Bouchier IA, Hayes PC. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis. J Hepatol. 1995 Mar;22(3):326-32. doi: 10.1016/0168-8278(95)80286-x

Kelbaek H, Rabøl A, Brynjolf I, Eriksen J, Bonnevie O, Godtfredsen J, et al. Haemodynamic response to exercise in patients with alcoholic liver cirrhosis. Clin Physiol. 1987 Feb;7(1):35-41. doi: 10.1111/j.1475-097x.1987.tb00631.x

Laffi G, Barletta G, La Villa G, Del Bene R, Riccardi D, Ticalin P, et al. Altered cardiovascular responsiveness to active tilting in nonalcoholic cirrhosis. Gastroenterology. 1997 Sep;113(3):891-8. doi: 10.1016/s0016-5085(97)70184-7

Wong F, Liu P, Lilly L, Bomzon A, Blendis L. Role of cardiac structural and functional abnormalities in the pathogenesis of hyperdynamic circulation and renal sodium retention in cirrhosis. Clinical Science. 1999;97(3):259–67.

Pozzi M, Carugo S, Boari G, Pecci V, de Ceglia S, Maggiolini S, et al. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. Hepatology. 1997 Nov;26(5):1131-7. doi: 10.1002/hep.510260507

Papastergiou V, Skorda L, Lisgos P, Papakonstantinou N, Giakoumakis T, Ntousikos K, et al. Ultrasonographic Prevalence and Factors Predicting Left Ventricular Diastolic Dysfunction in Patients with Liver Cirrhosis: Is There a Correlation between the Grade of Diastolic Dysfunction and the Grade of Liver Disease? The Scientific World Journal. 2012;615057. doi:10.1100/2012/615057

Sampaio F, Pimenta J. Left ventricular function assessment in cirrhosis: Current methods and future directions. World J Gastroenterol. Jan 7, 2016;22(1):112-125. doi: 10.3748/wjg.v22.i1.112

McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787-847. doi: 10.1093/eurheartj/ehs104