Zhang Kun, Braun Alexander, von Koeckritz Francisca, Schmuck Rosa B, Teegen Eva M, Cuspidi Cesare, Heinzel Frank, Pieske Burkert, Tadic Marijana
Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
J Clin Med. 2019 Aug 22;8(9):1285. doi: 10.3390/jcm8091285.
Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis.
This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline.
RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis.
RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.
关于酒精性肝硬化患者心脏重塑的数据较少。我们试图研究酒精性肝硬化患者的右心房（RA）和右心室（RV）结构、功能及力学情况。
这项回顾性横断面研究纳入了67例因肝移植评估而转诊的终末期肝硬化患者以及36名健康对照者。所有参与者均接受了超声心动图检查，包括离线进行的应变分析。
肝硬化患者的RV基底直径和RV厚度显著更高。各观察组之间RV收缩功能的常规参数相似。肝硬化患者的整体、心内膜和心外膜RV纵向应变显著更低。肝硬化患者的RA主动功能显著高于对照组。肝硬化患者的RA储存和管道应变显著更低，而RA收缩应变无差异。肝硬化患者舒张早期和收缩期RA应变率显著低于对照组，而两组之间RA舒张晚期应变率无差异。转氨酶和胆红素与终末期肝硬化患者的RV整体纵向应变和RV游离壁应变呈负相关。终末期肝病模型（MELD）评分作为3个月死亡率的预测指标，与终末期肝硬化患者的RV结构和收缩功能参数以及RA主动功能相关。
即使RV收缩功能得以保留，终末期肝硬化患者仍存在RA和RV重塑。肝酶、胆红素和MELD评分与RV和RA重塑相关。
