Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Hepatobiliary Pancreat Dis Int. 2011 Feb;10(1):50-4. doi: 10.1016/s1499-3872(11)60007-6.
Decreased cardiac contractility has been observed in cirrhosis, suggesting a latent cardiomyopathy in these patients. This study was designed to evaluate left ventricular structure and function in patients with end-stage liver disease by the model for end-stage liver disease (MELD) scoring system.
We recruited 82 patients (72 male, 10 female; mean age 50.3+/-8.9 years) with end-stage liver disease who underwent orthotopic liver transplantation between January 2002 and May 2008. Seventy-eight patients had cirrhosis and 4 had primary liver cancer. Patients were categorized into three groups on the basis of MELD score: ≤ 9 (27 patients, 33%); 10-19 (40, 49%); and ≥ 20 (15, 18%). The relationship between MELD score and cardiac structure and function was determined. Preoperative assessments of blood biochemistry, blood coagulation, serum virology, echocardiography and electrocardiography were performed.
MELD score was positively correlated with enlarged left atrial diameter, increased interventricular septum thickness (IVST), increased aortic flow, corrected QT interval (QTc) extension and cardiac output (P=0.033, 0.002, 0.000, 0.000 and 0.009, respectively). International normalized ratio also had a correlation with the above parameters and enlarged left ventricular end-diastolic diameter (P=0.043, 0.010, 0.000, 0.001, 0.016 and 0.008, respectively). Serum creatinine was positively correlated with IVST (r=0.257, P=0.020), but negatively correlated with early maximal ventricular filling velocity/late diastolic or atrial velocity ratio (r=-0.300, P=0.006). A difference of QTc >440 ms among the three groups was statistically significant (X2=9.791, P=0.007).
Abnormalities in cardiac structure and function are common in patients with end-stage liver disease. MELD score is a practically useful approach for the assessment of cardiac function in such patients.
在肝硬化患者中观察到心肌收缩力降低，这表明这些患者存在潜在的心肌病。本研究旨在通过终末期肝病模型（MELD）评分系统评估终末期肝病患者的左心室结构和功能。
我们招募了 82 名（72 名男性，10 名女性；平均年龄 50.3±8.9 岁）接受原位肝移植的终末期肝病患者，时间为 2002 年 1 月至 2008 年 5 月。78 名患者患有肝硬化，4 名患有原发性肝癌。根据 MELD 评分，患者分为三组：≤9（27 例，33%）；10-19（40 例，49%）；≥20（15 例，18%）。确定 MELD 评分与心脏结构和功能之间的关系。进行术前血液生化、凝血、血清病毒学、超声心动图和心电图检查。
MELD 评分与左心房内径增大、室间隔厚度增加（IVST）、主动脉血流增加、校正 QT 间期（QTc）延长和心输出量增加呈正相关（P=0.033、0.002、0.000、0.000 和 0.009）。国际标准化比值（INR）与上述参数和左心室舒张末期直径增大也有相关性（P=0.043、0.010、0.000、0.001、0.016 和 0.008）。血清肌酐与 IVST 呈正相关（r=0.257，P=0.020），但与早期最大心室充盈速度/晚期或心房速度比呈负相关（r=-0.300，P=0.006）。三组之间 QTc>440ms 的差异具有统计学意义（X2=9.791，P=0.007）。
终末期肝病患者的心脏结构和功能异常很常见。MELD 评分是评估此类患者心脏功能的一种实用方法。
