Yap Emily Mae L, Supe Myla Gloria S, Yu Ira I
Department of Adult Cardiology, Philippine Heart Center, Quezon City, Philippines.
Gastroenterology Unit, Department of Allied Medical Sciences, Philippine Heart Center, Quezon City, Philippines.
Cardiol Res. 2018 Dec;9(6):358-363. doi: 10.14740/cr804. Epub 2018 Dec 7.
Cardiac complications among patients with liver cirrhosis have not yet been described among Filipinos. Cirrhotic cardiomyopathy is a rarely described complication that has not been extensively described in literature. This is the first study to describe the electrocardiographic and echocardiographic findings of Filipino patients with liver cirrhosis.
A retrospective analytical study of 148 patients with liver cirrhosis from 2007 to 2016 at the Philippine Heart Center was done. The clinical characteristics, median QTc interval, systolic and diastolic functions on echocardiography of these patients were described. Spearman rho correlation was employed to determine the rank order correlation between QTc prolongation and the severity of liver cirrhosis. Fisher's Exact test was used to test the association of the echocardiographic parameters with the severity of liver cirrhosis.
The 10-year prevalence rate of liver cirrhosis at the Philippine Heart Center was 0.001% (148/137,584). The mean age was 72.4 ± 14 years with a female/male ratio of 1.1:1. The most common etiology of cirrhosis was hepatitis B or C infection (20%, 29). The Child-Pugh Classification (CPC) and Model for End-Stage Liver Disease (MELD) score were used to determine the severity of liver cirrhosis and to assess their prognosis. There were 31 patients (24%) with CPC-A, 84 patients (64%) with CPC-B and 15 patients (11%) with CPC-C. Fifty-five percent (n = 69) had a MELD score of 16 and below. Prolongation of the QTc interval was only seen among those with CPC A (median QTc of 470 ms) and a MELD score of 9 and below (median QTc of 485 ms). The mean left ventricular ejection fraction was 54.40±28.63%. There were five patients with a left ventricular ejection fraction of < 55%. The mean cardiac output (6.04 ± 5.24 L/min/m) and cardiac index (2.92 ± 1.47 L/min/m) were normal. There were 44 patients who had evidence of diastolic dysfunction based on an E/A ratio < 1, prolongation of isovolumic relaxation time (IVRT) of > 80 ms and prolongation of deceleration time (DT) of > 200 ms. There were only five patients who fulfilled the criteria for cirrhotic cardiomyopathy. A majority of the patients were discharged improved (82%). There were 26 cases who expired (18%).
A higher mean age of Filipinos with liver cirrhosis was reported in our study. Prolongation of the QTc interval was seen among those with early and late stage of cirrhosis (CPC A or MELD score ≤ 9 and CPC C). Most of these patients had normal left ventricular systolic function precluding the presence of cirrhotic cardiomyopathy.
菲律宾人中肝硬化患者的心脏并发症尚未见报道。肝硬化性心肌病是一种很少被描述的并发症，在文献中也没有被广泛描述。这是第一项描述菲律宾肝硬化患者心电图和超声心动图表现的研究。
对2007年至2016年在菲律宾心脏中心的148例肝硬化患者进行回顾性分析研究。描述了这些患者的临床特征、QTc间期中位数、超声心动图的收缩和舒张功能。采用Spearman秩相关分析来确定QTc延长与肝硬化严重程度之间的等级相关。使用Fisher精确检验来检验超声心动图参数与肝硬化严重程度之间的关联。
菲律宾心脏中心肝硬化的10年患病率为0.001%（148/137,584）。平均年龄为72.4±14岁，女性/男性比例为1.1:1。肝硬化最常见的病因是乙型或丙型肝炎感染（20%，29例）。采用Child-Pugh分类（CPC）和终末期肝病模型（MELD）评分来确定肝硬化的严重程度并评估其预后。有31例（24%）患者为CPC-A，84例（64%）为CPC-B，15例（11%）为CPC-C。55%（n = 69）的患者MELD评分为16及以下。仅在CPC A（QTc中位数为470毫秒）和MELD评分为9及以下（QTc中位数为485毫秒）的患者中观察到QTc间期延长。平均左心室射血分数为54.40±28.63%。有5例患者左心室射血分数<55%。平均心输出量（6.04±5.24升/分钟/米）和心脏指数（2.92±1.47升/分钟/米）正常。根据E/A比值<1、等容舒张时间（IVRT）延长>80毫秒和减速时间（DT）延长>200毫秒，有44例患者存在舒张功能障碍的证据。只有5例患者符合肝硬化性心肌病的标准。大多数患者出院时病情好转（82%）。有26例患者死亡（18%）。
我们的研究报告了菲律宾肝硬化患者的平均年龄较高。在肝硬化早期和晚期（CPC A或MELD评分≤9和CPC C）的患者中观察到QTc间期延长。这些患者中的大多数左心室收缩功能正常，排除了肝硬化性心肌病的存在。
