Barbosa Mara, Guardado Joana, Marinho Carla, Rosa Bruno, Quelhas Isabel, Lourenço António, Cotter José
Mara Barbosa, Joana Guardado, Carla Marinho, Bruno Rosa, Isabel Quelhas, António Lourenço, José Cotter, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4835 Guimarães, Portugal.
World J Hepatol. 2016 Jan 28;8(3):200-6. doi: 10.4254/wjh.v8.i3.200.
To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease.
A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected. Dobutamine stress echocardiography (conventional and tissue Doppler imaging) was performed. CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress. Therapy interfering with cardiovascular system was suspended 24 h before the examination.
Twenty-six patients were analyzed, 17 (65.4%) Child-Pugh A, mean model for end-stage liver disease (MELD) score of 8.7. The global proportion of patients with CCM was 61.5%. At rest, only 2 (7.7%) patients had diastolic dysfunction and none of the patients had systolic dysfunction. Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6 (23.1%) patients and of systolic dysfunction in 10 (38.5%) patients. QTc interval prolongation was observed in 68.8% of the patients and increased pro-BNP levels in 31.2% of them. There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD (P = 0.775, P = 0.532, respectively). Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation (95.0% vs 50.0%, P = 0.028).
CCM is a frequent complication of cirrhosis that is independent of liver impairment. Stress evaluation should always be performed, otherwise it will remain an underdiagnosed condition.
描述通过负荷超声心动图评估的肝硬化性心肌病（CCM）患者比例，并研究其与肝病严重程度的关联。
进行一项横断面研究。纳入无心血管疾病危险因素的肝硬化患者。收集有关肝病病因和严重程度（Child-Pugh评分和终末期肝病模型）、腹水和胃食管静脉曲张的存在情况、脑钠肽前体（pro-BNP）和校正QT（QTc）间期的数据。进行多巴酚丁胺负荷超声心动图（传统和组织多普勒成像）检查。当在静息状态或药物负荷后诊断出舒张期和/或收缩期功能障碍时，认为存在CCM。检查前24小时停用干扰心血管系统的治疗。
分析了26例患者，17例（65.4%）为Child-Pugh A级，终末期肝病模型（MELD）评分平均为8.7。CCM患者的总体比例为61.5%。静息状态下，仅2例（7.7%）患者有舒张功能障碍，无患者有收缩功能障碍。多巴酚丁胺负荷超声心动图显示，另有6例（23.1%）患者存在舒张功能障碍，10例（38.5%）患者存在收缩功能障碍。68.8%的患者观察到QTc间期延长，31.2%的患者脑钠肽前体水平升高。CCM的存在与通过Child-Pugh评分或MELD评估的肝功能损害之间无关联（P分别为0.775和0.532）。与无QTc间期延长的患者相比，QTc间期延长的患者胃食管静脉曲张发生率显著更高（95.0%对50.0%，P = 0.028）。
CCM是肝硬化常见的并发症，与肝功能损害无关。应始终进行负荷评估，否则将仍然是一种诊断不足的疾病状态。
