Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
PLoS One. 2019 Mar 19;14(3):e0212770. doi: 10.1371/journal.pone.0212770. eCollection 2019.
Cirrhotic cardiomyopathy (CCM) refers to cardiac dysfunction in patients with liver cirrhosis, in the absence of other known cardiac disease.
Control group and patients diagnosed of liver cirrhosis without known cardiac disease or hepatocellular carcinoma were enrolled for this clinical observation study. Patients with diabetes mellitus, hypertension were excluded. Absolute global longitudinal strain, one-point carotid pulse wave velocity (one-point PWV) and various parameters were measured in resting status.
There were 29 participants in the control group and 80 patients in the liver cirrhosis group. 27.8% of cirrhotic patients presented with normal systolic but abnormal diastolic functions and QTc prolongation that were compatible with CCM. 34.2% of cirrhotic patients presented with diastolic dysfunction in resting state comparing to 24.1% in control group. Systolic functions did not show conspicuous difference between cirrhosis and control group nor between compensated and decompensated cirrhosis, neither. Furthermore, one-point PWV was significantly higher in liver cirrhosis than in control group and higher in CCM than in non-CCM patients. One-point PWV predicted CCM and diastolic dysfunction in cirrhosis. Most importantly, its value > 1370cm/s predicted overall mortalities in decompensated cirrhosis (multivariable Cox analysis OR = 6.941) in addition to CTP score specifically in HCV related cirrhotic patients (AUC = 0.817).
In patients with cirrhosis, 27.8% were diagnosed with CCM by resting cardiovascular parameters. One-point PWV increased in CCM, correlated with diastolic dysfunction. It also correlated with overall mortality in patients with hepatitis C virus (HCV) related decompensated cirrhosis. Further study may be needed to confirm its capability for assessing CV and mortality risks in HCV related decompensated cirrhotic patients.
肝硬化性心肌病（CCM）是指在无其他已知心脏疾病的情况下，肝硬化患者出现的心脏功能障碍。
本临床观察研究纳入了确诊为无已知心脏疾病或肝细胞癌的肝硬化患者作为研究对象。排除了患有糖尿病和高血压的患者。在静息状态下测量了绝对整体纵向应变、单点颈动脉脉搏波速度（单点 PWV）和各种参数。
对照组有 29 名参与者，肝硬化组有 80 名患者。27.8%的肝硬化患者表现出正常的收缩但异常的舒张功能和 QTc 延长，这与 CCM 相符。与对照组（24.1%）相比，34.2%的肝硬化患者在静息状态下出现舒张功能障碍。肝硬化组和对照组的收缩功能没有明显差异，代偿性和失代偿性肝硬化之间也没有明显差异。此外，单点 PWV 在肝硬化组明显高于对照组，在 CCM 患者中明显高于非 CCM 患者。单点 PWV 预测了肝硬化中的 CCM 和舒张功能障碍。最重要的是，其值>1370cm/s 不仅可以预测失代偿性肝硬化（多变量 Cox 分析 OR = 6.941）的总死亡率，还可以预测丙型肝炎病毒（HCV）相关肝硬化患者的 CTP 评分（AUC = 0.817）。
在肝硬化患者中，27.8%通过静息心血管参数诊断为 CCM。单点 PWV 在 CCM 中增加，与舒张功能障碍相关。它还与丙型肝炎病毒（HCV）相关失代偿性肝硬化患者的总死亡率相关。可能需要进一步的研究来确认其在评估 HCV 相关失代偿性肝硬化患者的心血管和死亡率风险方面的能力。
