EVALUATION AND CORRELATION OF CARDIOVASCULAR DYSFUNCTION IN NONALCOHOLIC CIRRHOTIC PATIENTS WITH ITS SEVERITY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 73
Abstract
BACKGROUND The presence of cardiocirculatory dysfunction in liver cirrhosis has been described since 1960s, but it was erroneously attributed to alcoholic cardiomyopathy. Only in the last 2 decades, has it been shown that cardiac dysfunction is also present in nonalcoholic cirrhosis indicating the presence of a latent cardiac dysfunction known as "cirrhotic cardiomyopathy.” The aim of the study is to evaluate the cardiovascular dysfunction in nonalcoholic cirrhosis of liver and its correlation with the severity of cirrhosis of liver. MATERIALS AND METHODS In the descriptive study, 70 patients of nonalcoholic cirrhosis liver were taken up and were assessed for detection of cirrhosis and its complications and classified by Child-Pugh class. Cardiological function was evaluated in these patients by various parameters like clinical, ECG, Doppler echocardiography (systolic function, diastolic function, cardiac output and cardiac index) and proBNP and association with severity of cirrhosis of liver was assessed. RESULTS Cardiovascular evaluation of the patients in the study revealed ECG abnormality as QTc interval prolongation in 47 patients (67.1%). Echocardiography revealed 51.4% patients having decreased ejection fraction and 40% patients had decreased fractional shortening. 29 patients (41.4%) had stage I diastolic dysfunction (impaired relaxation) and 28 patients (40%) were found to be in stage II diastolic dysfunction. Increase in serum proBNP levels was found in 20 patients (28.6%), cardiac output and cardiac index were decreased in 18 patients (25.7%) each. On analysing for correlation and associations, it was found that patients of cirrhosis having ECG abnormalities (QTc interval prolongation), increased systolic and diastolic dysfunction, increased left atrial diameter, decreased cardiac output, decreased cardiac index and increase in proBNP levels were significantly associated (p value <0.05) with increased Child-Pugh class, increased presence of hepatorenal syndrome, spontaneous bacterial peritonitis and hyponatraemia in cirrhotic patients. CONCLUSION This study showed the presence of cardiological dysfunction in nonalcoholic cirrhotic patients and a statistically significant association of the cardiological dysfunction with the severity of cirrhosis, which revealed the latent entity known as cirrhotic cardiomyopathy. Studies of cardiovascular abnormalities in cirrhosis of liver are scarce in literature, though other organ dysfunctions are well established. Hence, all cases of cirrhosis of liver should be periodically evaluated for presence of cardiac dysfunction, so that early intervention will reduce long-term morbidity and mortality.
Authors and Affiliations
Subhas Bhuin, Rina Mohanty
Keywords
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- EP ID EP265818
- DOI 10.14260/Jemds/2017/1130
- Views 93
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