Chen Yan, Chan Albert C, Chan See-Ching, Chok Siu-Ho, Sharr William, Fung James, Liu Ju-Hua, Zhen Zhe, Sin Wai-Ching, Lo Chung-Mau, Tse Hung-Fat, Yiu Kai-Hang
Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Division of Surgery, The University of Hong Kong, Hong Kong, China.
J Cardiol. 2016 Feb;67(2):140-6. doi: 10.1016/j.jjcc.2015.08.001. Epub 2015 Aug 21.
Cirrhosis has been shown to be associated with left ventricular (LV) myocardial dysfunction, but studies of right ventricular (RV) function in cirrhotic patients compared with controls are scarce. Limited studies have prospectively evaluated the progression of myocardial function in patients with cirrhosis and assessed changes in cardiac function following liver transplantation (LTx). So the aim of the study was to evaluate biventricular myocardial function in cirrhotic patients and its alteration with or without liver transplantation.
A total of 103 patients with cirrhosis (age 55±7 years, male 75%) were recruited. Conventional and 2-dimensional speckle tracking echocardiography was performed to determine the presence of LV and RV (biventricular) dysfunction. For comparison, 48 matched control subjects were included. Follow-up echocardiography was performed in 41 patients following LTx and in 26 patients who did not undergo LTx.
Patients with cirrhosis had biventricular dilatation, increased LV mass, impaired LV diastolic function, and biventricular systolic strain compared with controls. Following LTx, cirrhotic patients had reduced biventricular dilatation, a smaller LV mass, and improved biventricular systolic strain after a mean duration of 18.2±6.6 months. Patients who did not undergo LTx had a further increase in LV mass but no significant change in biventricular dimensions or systolic strain (mean duration of 20.4±8.3 months).
The present study demonstrates that patients with cirrhosis had biventricular dilatation and impaired biventricular systolic strain compared with controls. Following LTx, biventricular dilatation reduced and biventricular systolic strain improved. In contrast, patients who did not undergo LTx experienced a further increase in LV mass.
肝硬化已被证明与左心室（LV）心肌功能障碍有关，但与对照组相比，关于肝硬化患者右心室（RV）功能的研究较少。有限的研究前瞻性评估了肝硬化患者心肌功能的进展，并评估了肝移植（LTx）后心脏功能的变化。因此，本研究的目的是评估肝硬化患者的双心室心肌功能及其在肝移植与否情况下的改变。
共招募了103例肝硬化患者（年龄55±7岁，男性占75%）。采用传统及二维斑点追踪超声心动图来确定左心室和右心室（双心室）功能障碍的存在。为作比较，纳入了48例匹配的对照受试者。对41例接受肝移植的患者和26例未接受肝移植的患者进行了随访超声心动图检查。
与对照组相比，肝硬化患者存在双心室扩张、左心室质量增加、左心室舒张功能受损以及双心室收缩应变降低。肝移植后，肝硬化患者在平均18.2±6.6个月的时间后，双心室扩张减轻、左心室质量减小且双心室收缩应变改善。未接受肝移植的患者左心室质量进一步增加，但双心室尺寸或收缩应变无显著变化（平均时间为20.4±8.3个月）。
本研究表明，与对照组相比，肝硬化患者存在双心室扩张和双心室收缩应变受损。肝移植后，双心室扩张减轻，双心室收缩应变改善。相比之下，未接受肝移植的患者左心室质量进一步增加。
