Sattarzadeh-Badkoubeh Roya, Geraiely Babak, Nassiri-Toosi Mohssen, Jafarian Ali
Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2015 Aug;53(8):476-81.
We assessed different systolic cardiac indices to detect left and right ventricular systolic dysfunction in cirrhotic patients before liver transplantation. Between 2010-2011, 81 consecutive individuals with confirmed hepatic cirrhosis who were a candidate for liver transplantation were enrolled in this study. A total of 32 age and sex matched healthy volunteers were also selected as the control group. A detailed two-dimensional, Color Flow Doppler, and Tissue Doppler echocardiography were performed in all patients and control participants. Left atrial diameter and area, right atrial area, left ventricular end diastolic volume, and basal right ventricular diameter were significantly higher in the cirrhotic group (P<0.05). Left ventricular ejection fraction, stroke volume, left ventricular outflow tract velocity time integral and tricuspid annular plane systolic excursion were also higher in the cirrhotic group (P<0.05). Peak systolic velocities of tricuspid annulus, basal segment of RV free wall and basal segment of septal wall, peak strains of basal and mid portions of septal wall, mid portion of lateral wall and peak strain rates of basal and mid portions of septal and lateral walls were higher significantly in cirrhotic group, as well (P<0.05). Isovolumic contraction time, LV systolic time interval and Tei indexes of left and right ventricles which all are representatives of systolic dysfunction were higher in cirrhosis. Peak systolic velocity of a mid-segment of the lateral wall was lower in the cirrhotic group (P<0.05) as well. Most of the cirrhotic patients display signs of cardiovascular disturbances that become more manifest following exposure to stresses such as transplantation. Cardiac failure is an important cause of death following liver transplantation. Because of the load dependency we cannot use most of the cardiac systolic indices for evaluation of systolic function in cirrhotic patients. Thus, we suggest that LV systolic time interval and Tei indices of left and right ventricles might be useful indices in the evaluation of systolic function in cirrhotic patients.
我们评估了不同的心脏收缩指数，以检测肝硬化患者肝移植前左、右心室收缩功能障碍。在2010年至2011年期间，本研究纳入了81例确诊为肝硬化且有肝移植指征的连续患者。还选取了32名年龄和性别匹配的健康志愿者作为对照组。对所有患者和对照参与者进行了详细的二维、彩色多普勒和组织多普勒超声心动图检查。肝硬化组的左心房直径和面积、右心房面积、左心室舒张末期容积和右心室基底段直径显著更高（P<0.05）。肝硬化组的左心室射血分数、每搏输出量、左心室流出道速度时间积分和三尖瓣环平面收缩期位移也更高（P<0.05）。肝硬化组三尖瓣环、右心室游离壁基底段和室间隔基底段的收缩期峰值速度、室间隔基底和中间部分、侧壁中间部分的峰值应变以及室间隔和侧壁基底和中间部分的峰值应变率也显著更高（P<0.05）。代表收缩功能障碍的等容收缩时间、左心室收缩时间间期以及左、右心室的Tei指数在肝硬化患者中更高。肝硬化组侧壁中间段的收缩期峰值速度也更低（P<0.05）。大多数肝硬化患者表现出心血管紊乱的迹象，在经历如移植等应激后会更加明显。心力衰竭是肝移植后死亡的重要原因。由于负荷依赖性，我们不能使用大多数心脏收缩指数来评估肝硬化患者的收缩功能。因此，我们建议左心室收缩时间间期以及左、右心室的Tei指数可能是评估肝硬化患者收缩功能的有用指标。
