Hepatogastroenterology Unit, 1st Department of Medicine Propaedeutic, Medical School of Athens, Laikon General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece,
Dig Dis Sci. 2013 Oct;58(10):3029-36. doi: 10.1007/s10620-013-2693-y. Epub 2013 Aug 2.
The cardiac dysfunction presented in cirrhotic patients is already known as cirrhotic cardiomyopathy. The pathogenesis of this entity is not fully understood.
The aim of this study was to evaluate the frequency and characteristics of cirrhotic cardiomyopathy and to investigate the possible role of bacterial endotoxemia on its aggravation.
Forty-five cirrhotics were studied by a tissue Doppler imaging echocardiography at rest and after stress. The diagnosis of left ventricular diastolic dysfunction was based on the latest guidelines of the American Society of Echocardiography, whereas its severity was defined by the E/e'av ratio. Endotoxemia was estimated by measuring the serum levels of lipopolysaccharide-binding protein (LBP) and cytokines.
None of the patients had systolic dysfunction, but 17/45 (37.8 %) had a diastolic one. Patients with grade II diastolic dysfunction had significantly longer QTc (p = 0.049), larger left atrium volume (p = 0.013), higher Brain Natriuretic Peptide levels (p = 0.007) and higher LBP levels (p = 0.02), compared to those with normal cardiac function, without differences in the systemic hemodynamics and the cytokines' levels. Moreover, the severity of diastolic dysfunction as reflected by the E/e'av. was significantly correlated with the LBP levels (p = 0.002). On the multivariate analysis, the LBP was independently associated with the presence of diastolic dysfunction.
Cirrhosis is commonly complicated by cardiac dysfunction. Patients with severe cirrhotic cardiomyopathy have higher LBP levels, which are significantly correlated with the degree of diastolic dysfunction. Our findings support a potential role of bacterial endotoxemia on the aggravation of cardiomyopathy in cirrhotic patients.
肝硬化患者出现的心脏功能障碍已被称为肝硬化性心肌病。其发病机制尚未完全阐明。
本研究旨在评估肝硬化性心肌病的发生率和特征，并探讨内毒素血症在其加重中的可能作用。
45 例肝硬化患者在静息和应激状态下进行组织多普勒成像超声心动图检查。左心室舒张功能障碍的诊断依据美国超声心动图学会的最新指南，其严重程度通过 E/e' av 比值定义。通过测量血清脂多糖结合蛋白（LBP）和细胞因子水平来估计内毒素血症。
无患者存在收缩功能障碍，但 17/45（37.8%）存在舒张功能障碍。舒张功能障碍 II 级患者的 QTc 显著延长（p=0.049），左心房容积更大（p=0.013），脑钠肽水平更高（p=0.007），LBP 水平更高（p=0.02），与心功能正常的患者相比，而在系统血液动力学和细胞因子水平方面无差异。此外，E/e' av 反映的舒张功能障碍严重程度与 LBP 水平显著相关（p=0.002）。多变量分析显示，LBP 与舒张功能障碍的存在独立相关。
肝硬化常并发心脏功能障碍。严重肝硬化性心肌病患者的 LBP 水平更高，与舒张功能障碍程度显著相关。我们的研究结果支持内毒素血症在加重肝硬化患者心肌病方面的潜在作用。
