Division of Hepatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
Clin Mol Hepatol. 2018 Dec;24(4):409-416. doi: 10.3350/cmh.2018.0034. Epub 2018 Aug 27.
BACKGROUND/AIMS: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC.
We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival.
Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ≥ 10 (LVDD grade 2) had lower survival than patients with E/e' ratio < 10.
The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.
背景/目的：左心室舒张功能障碍（LVDD）是肝硬化（LC）患者心功能障碍的早期表现。然而，LVDD 对生存率的影响尚未明确，尤其是在失代偿性 LC 中。
我们前瞻性地纳入了 2013 年 4 月至 2015 年 4 月在大田圣玛丽医院就诊的 70 例失代偿性 LC 患者，包括腹水或静脉曲张出血。这些患者的心脏功能通过二维超声心动图联合组织多普勒成像进行评估。LVDD 的诊断基于美国超声心动图学会指南。主要终点是总生存率。
44 例（62.9%）患者存在 LVDD。在随访期间（22.3 个月），18 例患者死亡（16 例伴有 LVDD，2 例无 LVDD）。LVDD 患者的生存率明显低于无 LVDD 患者（31.1 个月 vs. 42.6 个月，P=0.01）。多变量分析显示，Child-Pugh 评分和 LVDD 是生存率的独立预测因素。此外，早期充盈速度与早期舒张二尖瓣环速度比（E/e'）≥10（LVDD 分级 2）的患者生存率低于 E/e'比值<10 的患者。
失代偿性 LC 患者存在 LVDD 与生存率降低相关。因此，监测和密切随访 LVDD 患者可能很重要。
