Shukla Akash, Bhatt Pratin, Gupta Deepak Kumar, Modi Tejas, Patel Jatin, Phadke Milind, Rathod Krantikumar, Meshram Megha, Bhatia S J
Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Room 1120, Multistory Building, 11th floor, Parel, Mumbai, 400 012, India.
Department of Cardiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400 012, India.
Indian J Gastroenterol. 2017 Nov;36(6):474-480. doi: 10.1007/s12664-017-0811-z. Epub 2018 Jan 24.
Cirrhotic cardiomyopathy (CCM) is associated with high mortality after transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation in patients with cirrhosis. There is no data about the prevalence or impact of CCM in Budd-Chiari syndrome (BCS). We assessed the prevalence of CCM in patients with BCS and its impact on outcome after radiological intervention.
Thirty-three consecutive patients with BCS (15 men) and 33 controls with hepatitis B-related cirrhosis (18 men, matched for Child-Pugh score) were evaluated with baseline electrocardiography (ECG), echocardiography (ECHO) and dobutamine stress ECHO, and ECG (DSE). The two groups were compared for prevalence of CCM. Patients with BCS with and without CCM were assessed for development of heart failure, duration of intensive care unit (ICU) stay, and in-hospital mortality immediately after radiological intervention.
Fewer patients with BCS had CCM (7/21 vs. 21/33; p = 0.001, OR-0.16, CI [0.05-0.5]), diastolic dysfunction (DD) (0/33 vs. 6/33; p = 0.01, OR-0.06, CI [0.00-1.1]), and prolonged QTc interval (5/33 vs.17/33; p = 0.001, OR-0.16, CI [0.05-0.5]) despite correction for age. Patients with BCS had lower end-systolic and end-diastolic volumes of left and right ventricles. None of the 19 patients (five with CCM) with BCS undergoing radiological intervention (12 TIPS, 4 inferior vena cava, and 3 hepatic vein stenting) developed heart failure or had prolonged ICU stay. There was no in-hospital mortality.
Patients with BCS have lower frequency of CCM as compared to patients with cirrhosis. CCM may not adversely affect outcomes after radiological interventions.
肝硬化性心肌病（CCM）与肝硬化患者经颈静脉肝内门体分流术（TIPS）及肝移植后的高死亡率相关。目前尚无关于布加综合征（BCS）中CCM的患病率或影响的数据。我们评估了BCS患者中CCM的患病率及其对放射介入治疗后结局的影响。
对33例连续的BCS患者（15例男性）和33例乙型肝炎相关肝硬化对照患者（18例男性，按Child-Pugh评分匹配）进行基线心电图（ECG）、超声心动图（ECHO）和多巴酚丁胺负荷超声心动图及心电图（DSE）检查。比较两组CCM的患病率。对有和无CCM的BCS患者评估心力衰竭的发生情况、重症监护病房（ICU）住院时间及放射介入治疗后即刻的院内死亡率。
BCS患者中CCM（7/21 vs. 21/33；p = 0.001，OR - 0.16，CI [0.05 - 0.5]）、舒张功能障碍（DD）（0/33 vs. 6/33；p = 0.01，OR - 0.06，CI [0.00 - 1.1]）及QTc间期延长（5/33 vs. 17/33；p = 0.001，OR - 0.16，CI [0.05 - 0.5]）的发生率更低，尽管已校正年龄。BCS患者左、右心室的收缩末期和舒张末期容积更低。19例接受放射介入治疗（12例行TIPS，4例行下腔静脉支架置入，3例行肝静脉支架置入）的BCS患者（5例有CCM）均未发生心力衰竭或ICU住院时间延长。无院内死亡病例。
与肝硬化患者相比，BCS患者中CCM的发生率更低。CCM可能不会对放射介入治疗后的结局产生不利影响。
