Valeriano V, Funaro S, Lionetti R, Riggio O, Pulcinelli G, Fiore P, Masini A, De Castro S, Merli M
II Gastroenterologia e Dipartimento di Medicina Clinica, Università degli Studi di Roma La Sapienza, Rome, Italy.
Am J Gastroenterol. 2000 Nov;95(11):3200-5. doi: 10.1111/j.1572-0241.2000.03252.x.
Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study we investigated cardiac function in cirrhotic patients and in controls.
A total of 20 cirrhotic patients without previous or ongoing ascites, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy controls were studied by two-dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according to Ganau's criteria. Diastolic function was evaluated by the peak filling velocity of E wave and A wave, E/A ratio, and deceleration time of E wave. The pulmonary systolic arterial pressure was also estimated in patients with tricuspid insufficiency.
Right and left atrium and right ventricle diameters were significantly enlarged in cirrhotic patients versus controls. E/A ratio was decreased (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without ascites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systolic arterial pressure was slightly elevated in patients with ascites (35 +/- 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patients) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05). The pattern of left ventricular geometry was normal in the majority of patients. Nitrite and nitrate levels were increased in cirrhotics irrespective of the presence of ascites.
Liver cirrhosis is associated with enlarged right cardiac chambers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites. These changes do not depend on variations in the left ventricular geometry.
已有报道称肝硬化患者存在心脏功能异常，提示这些患者存在潜在的心肌病。在本研究中，我们调查了肝硬化患者和对照组的心脏功能。
通过二维多普勒超声心动图对20例既往无腹水且目前无腹水的肝硬化患者、20例中重度腹水的肝硬化患者以及10例健康对照者进行研究。评估心脏大小及左、右心室功能。根据加瑙标准计算左心室几何形态。通过E波和A波的峰值充盈速度、E/A比值以及E波减速时间评估舒张功能。对于存在三尖瓣关闭不全的患者，还估算了肺动脉收缩压。
与对照组相比，肝硬化患者的右心房、左心房和右心室直径显著增大。有腹水患者的E/A比值（0.9±0.2）低于无腹水患者（1.3±0.4）及对照组（1.3±1）（p<0.05）。有腹水患者的估算肺动脉收缩压（35±5mmHg，6例患者）略高于无腹水患者（28±5，10例患者）及对照组（27±8，6例对照者，方差分析，p<0.05）。大多数患者的左心室几何形态模式正常。无论有无腹水，肝硬化患者的亚硝酸盐和硝酸盐水平均升高。
肝硬化与右心腔扩大有关。有腹水的肝硬化患者存在舒张功能障碍和轻度肺动脉高压。这些变化不依赖于左心室几何形态的改变。
