Clin Mol Hepatol.  2018 Dec;24(4):409-416. 10.3350/cmh.2018.0034.

Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis

• Lee SK
• Song MJ
• Kim SH
• Ahn HJ

• KMID: 2433306
• DOI: http://doi.org/10.3350/cmh.2018.0034

Abstract

BACKGROUND/AIMS
Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC.
METHODS
We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival.
RESULTS
Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ≥ 10 (LVDD grade 2) had lower survival than patients with E/e' ratio < 10.
CONCLUSIONS
The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

Keyword

Liver cirrhosis; Diastolic heart failure; Cardiomyopathies; Echocardiography

MeSH Terms

Ascites
Cardiomyopathies
Diagnosis
Echocardiography
Esophageal and Gastric Varices
Follow-Up Studies
Heart Failure, Diastolic
Humans
Liver Cirrhosis*
Liver*
Multivariate Analysis
Prognosis*
Prospective Studies
Survival Rate