Biventricular dysfunction in patients with liver cirrhosis

Abstract

OBJECTIVE: Patient with liver cirrhosis is associated with left ventricular (LV) myocardial dysfunction. However, studies on the right ventricular (RV) function in these patients are limited. The aim of this study thus was to evaluate both LV and RV function in patients with cirrhosis. METHODS: A total of 103 cirrhosis patients (age 54.9±7.3 years, 74.8% male) and 48 age- and gender-matched healthy controls were included. Detail transthoracic echocardiography were performed in all subjects. Conventional echocardiography parameters including LV dimension, LV ejection fraction, RV dimension and RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) were measured. In addition, advanced speckle-tracking derived strain analysis to detect subtle LV and RV systolic dysfunction were measured. Global LV strains were assessed from three orthogonal directions: longitudinal (LS), circumferential (CS), and radial strain (RS). Global RV longitudinal strain (RV-LS) including the RV free wall and septum were measured. RESULTS: Both LV and RV dimension were comparable between patients with cirrhosis and controls. Despite similar LV ejection fraction (65.1±4.8% vs. 64.1±4.4%; P=0.193) and TAPSE (2.37±0.43 vs. 2.34±0.24; P=0.592), patients with cirrhosis had impaired global LS (-18.5±2.9% vs. -20.1±2.8%, P<0.01), CS (-16.6±2.4% vs. -21.6±3.6%, P<0.01), RS (39.9±13.1% vs. 44.9±14.3%, P<0.05) and RV-LS (-21.2±4.4% vs. -23.0±2.6%, P<0.01) compared with controls. Upon multivariable adjustment with age, gender and cardiovascular risk factors, both global LV and RV strains remained significantly impaired in patients with cirrhosis. CONCLUSIONS: In addition to impaired LV systolic function, the present study firstly demonstrated that patients with cirrhosis had concomitant RV systolic dysfunction assessed by speckle tracking derived strain. This data thus suggested patients with cirrhosis had biventricular myocardial dysfunction.