Gastroenterologia, Dipartimento Medicina Clinica, Sapienza Università di Roma, Italy.
Eur J Intern Med. 2013 Mar;24(2):172-6. doi: 10.1016/j.ejim.2012.08.007. Epub 2012 Sep 5.
Cirrhotic cardiomiopathy is described as the presence of cardiac dysfunction in cirrhotic patients. The aim of the study was to investigate factors associated with cardiac dysfunction in cirrhotic patients.
Seventy-four cirrhotic patients and twenty-six controls performed a conventional echocardiography and Tissue Doppler Imaging (TDI) for systolic and diastolic function. Results were analyzed by using the Guidelines of American Society of Echocardiography.
In patients with cirrhosis, left ventricular end-diastolic diameter was increased (p<0.001) , peak systolic velocities were decreased (11.3±2.7 vs 13.9±1.4cm/s; p<0.001) and left atrial volumes were increased (32.7±8.3 vs 24±8.5ml, p<0.001) as well as cardiac mass (90.6±23 vs 70.5±22g/m(2), p<0.001). Forty-seven cirrhotic patients (64%) showed diastolic dysfunction at rest: grade I in 37 and grade II in 10 patients. Systolic and/or diastolic dysfunction were not influenced by a more severe liver impairment. Diastolic dysfunction was more prevalent in patients with ascites vs those without (77% vs 56%; p=0.04).
A mild diastolic dysfunction at rest is frequent in cirrhotic patients but cardiac load conditions are confounding factors in this diagnosis. We did not identify an association between severity of liver disease and cardiac dysfunction.
肝硬化性心肌病是指肝硬化患者存在心脏功能障碍。本研究旨在探讨肝硬化患者心脏功能障碍的相关因素。
74 例肝硬化患者和 26 例对照者进行了常规超声心动图和组织多普勒成像(TDI)检查,以评估收缩和舒张功能。结果分析采用美国超声心动图学会指南。
在肝硬化患者中,左心室舒张末期直径增加(p<0.001),收缩期峰值速度降低(11.3±2.7 比 13.9±1.4cm/s;p<0.001),左心房容积增加(32.7±8.3 比 24±8.5ml,p<0.001),以及心脏质量增加(90.6±23 比 70.5±22g/m2,p<0.001)。47 例(64%)肝硬化患者在休息时存在舒张功能障碍:37 例为 I 级,10 例为 II 级。更严重的肝损伤并不影响收缩和/或舒张功能障碍。有腹水的患者比没有腹水的患者更易出现舒张功能障碍(77%比 56%;p=0.04)。
肝硬化患者在休息时常常存在轻度舒张功能障碍,但心脏负荷情况是影响这种诊断的混杂因素。我们没有发现肝脏疾病严重程度与心脏功能障碍之间存在关联。