Li Xiaopeng, Yu Shanshan, Li Lu, Han Donggang, Dai Shejiao, Gao Ya
Department of Ultrasonic Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine Xi'an, China ; Department of Pediatric Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine Xi'an, China.
Department of Ultrasonic Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine Xi'an, China.
Int J Clin Exp Med. 2014 Dec 15;7(12):5751-7. eCollection 2014.
The purpose of our study is to investigate cirrhosis-related left ventricular remodeling and functional changes, further to analyze the correlations with model for end-stage liver disease (MELD) score.
A total of 89 cirrhotic patients were enrolled for study and subgrouped according to MELD score: ≤ 9, 10-19, and ≥ 20. Thirty healthy individuals were enrolled as controls. All study participants underwent cardiac assessment of the left ventricle with Doppler echocardiography; the parameters assessed included left ventricular-end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), cardiac output (CO), mitral flow velocity (VE/VA ratio), and E-wave deceleration time (DT).
The cirrhotic patients had significantly higher LVESD, LVEDD, IVST, LAD, CO and DT than the control group, but significantly lower VE/VA ratio (all P < 0.05). Subgroup analysis showed that the higher the MELD score, the greater the increase in LVESD, LVEDD, IVST, LAD and DT (all P < 0.05). Nearly one-half of the cirrhotic patients showed left atrial enlargement and a VE/VA ratio ≤ 1, and these features were more common in patients with MELD score ≥ 20. LAD, LVEDD and DT were positively correlated with MELD score (r = 0.208, 0.319 and 0.197, respectively; all P < 0.05).
Patients with cirrhosis had impaired cardiac function, mainly present as left ventricular diastolic dysfunction, and the extent of dysfunction was correlated with the MELD score. Left atrial enlargement and VE/VA ratio ≤ 1 may serve as useful diagnostic indexes for cirrhotic cardiomyopathy.
本研究旨在探讨肝硬化相关的左心室重构及功能变化，并进一步分析其与终末期肝病模型（MELD）评分的相关性。
共纳入89例肝硬化患者，并根据MELD评分进行分组：≤9分、10 - 19分和≥20分。纳入30名健康个体作为对照组。所有研究参与者均通过多普勒超声心动图对左心室进行心脏评估；评估的参数包括左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心房内径（LAD）、左心室射血分数（LVEF）、心输出量（CO）、二尖瓣血流速度（VE/VA比值）和E波减速时间（DT）。
肝硬化患者的LVESD、LVEDD、IVST、LAD、CO和DT显著高于对照组，但VE/VA比值显著低于对照组（均P < 0.05）。亚组分析显示，MELD评分越高，LVESD、LVEDD、IVST、LAD和DT的增加幅度越大（均P < 0.05）。近一半的肝硬化患者出现左心房扩大且VE/VA比值≤1，这些特征在MELD评分≥20分的患者中更为常见。LAD、LVEDD和DT与MELD评分呈正相关（r分别为0.208、0.319和0.197；均P < 0.05）。
肝硬化患者存在心功能受损，主要表现为左心室舒张功能障碍，且功能障碍程度与MELD评分相关。左心房扩大和VE/VA比值≤1可作为肝硬化性心肌病的有用诊断指标。
