Wroński Jakub, Fiedor Piotr, Kwolczak Monika, Górnicka Barbara
Students Scientific Group at Department of Pathology, Medical University of Warsaw, Chałubińskiego 5, 02-004 Warszawa, Poland; Students Scientific Group at Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warszawa, Poland.
Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warszawa, Poland.
Pathol Res Pract. 2015 Feb;211(2):145-9. doi: 10.1016/j.prp.2014.10.012. Epub 2014 Nov 5.
Cirrhotic cardiomyopathy is a chronic cardiac dysfunction in patients with liver cirrhosis. It is mostly characterized by impaired cardiac function, but some myocardial anatomical changes have also been described. The aim of this study was to assess the influence of liver cirrhosis on heart wall thickness changes in a retrospective pathological analysis of cirrhotic patients without hypertension.
Statistical analysis of 11,860 autopsy protocols drawn up between 1981 and 2002 in the Department of Pathology Medical University of Warsaw was done.
Liver cirrhosis was confirmed by autopsy in 802 patients (6.7%); in 697 patients, hypertension was excluded. Analysis of heart wall thickness showed pathological changes in 53.2% of patients - left ventricular thickening in 9.3%, right ventricular thinning in 31.0%, and both in 12.9%. In clinical assessment, the cause of death in 25.8% of patients was cardiocirculatory failure, significantly more in the group with selective left ventricular thickening. It was the most common cause of death among them. Vascular changes in the upper gastrointestinal tract, liver enlargement and hepatic coma were also significantly related to the heart wall thickness changes occurrence.
Based on statistical analysis of autopsy material, we concluded that liver cirrhosis can lead to heart wall thickness changes (left ventricular thickening and/or right ventricular thinning). We revealed that patients with selective left ventricular thickening had significantly more cardiac related causes of death. In clinical practice, treatment of cirrhotic cardiomyopathy requires specialized diagnostics and appropriate cardiological procedures involving the participation of a hepatologist, especially in the group of patients with selective left ventricular hypertrophy.
肝硬化性心肌病是肝硬化患者的一种慢性心脏功能障碍。其主要特征为心功能受损,但也有一些心肌解剖学改变的描述。本研究的目的是通过对无高血压的肝硬化患者进行回顾性病理分析,评估肝硬化对心脏壁厚度变化的影响。
对1981年至2002年华沙医科大学病理科制定的11,860份尸检报告进行统计分析。
尸检确诊肝硬化患者802例(6.7%);排除697例高血压患者。心脏壁厚度分析显示,53.2%的患者存在病理改变——左心室增厚9.3%,右心室变薄31.0%,两者均有改变12.9%。临床评估中,25.8%的患者死因是心循环衰竭,在选择性左心室增厚组中显著更多。这是其中最常见的死因。上消化道血管改变、肝脏肿大和肝昏迷也与心脏壁厚度改变的发生显著相关。
基于尸检材料的统计分析,我们得出结论,肝硬化可导致心脏壁厚度改变(左心室增厚和/或右心室变薄)。我们发现,选择性左心室增厚的患者心脏相关死因显著更多。在临床实践中,肝硬化性心肌病的治疗需要专业诊断以及包括肝病专家参与的适当心脏程序,尤其是在选择性左心室肥厚患者群体中。