Karki Niyanta, Kc Sudhamshu, Sharma Dilip, Jaisi Bikash, Khadka Sandip
Department of Medicine, Liver Unit, Bir hospital, Kathmandu, Nepal.
J Nepal Health Res Counc. 2019 Nov 13;17(3):357-361. doi: 10.33314/jnhrc.v17i3.1969.
The clinical picture in cirrhosis is dominated by the classical complications such as ascites, bleeding varices, portal hypertension and encephalopathy. Cardiac dysfunction in patients with cirrhosis, which contributes significantly to the morbidity and, mortality though prevalent, is less studied and not widely recognized entity since it is largely asymptomatic at rest, with overt heart failure seen mainly during pharmacological stress, transjugular intrahepatic portosystemic shunt, liver transplantation.
It is a cross sectional study done on patients admitted in wards or attending to outpatient department of Liver unit, Bir Hospital, between May 2015 to May 2016. Diagnosis of cirrhosis was based on clinical examination, lab parameters, ultrasound examination, endoscopy and/or liver biopsy. Cirrhotic patients after assessing the exclusion criteria were recruited for the study. Child Pugh and model for end stage liver disease scores were calculated to assess the liver function. Cardiac function was evaluated by resting pulse, mean arterial pressure, electrocardiography, and 2 dimensional echocardiography.
Diastolic dysfunction was seen in 61.9%(48) and was more common in alcoholic group (63.2% Vs 58.6%). Systolic dysfunction was seen in 6.6% of alcoholic patients only. 51.4% had cirrhotic cardiomyopathy according to the criteria (proposed by World congress of gastroenterology in 2005). Prolonged QTc of >0.44 seconds was noted in 79%, mainly in child pugh C, with model for end stage liver disease score >10.
Cardiac dysfunction is prevalent with sizeable number of patients with cirrhosis especially in the form of diastolic dysfunction independent of etiology. QTc prolongation might be an early indicator of cardiac dysfunction and is directly correlated with child pugh and model for end stage liver disease scores.
肝硬化的临床表现主要由诸如腹水、静脉曲张出血、门静脉高压和肝性脑病等经典并发症主导。肝硬化患者的心脏功能障碍虽然普遍存在，但对发病率和死亡率有显著影响，却较少被研究且未得到广泛认可，因为其在静息状态下大多无症状，明显的心力衰竭主要出现在药物应激、经颈静脉肝内门体分流术、肝移植期间。
这是一项横断面研究，于2015年5月至2016年5月期间对在比尔医院肝病科病房住院或门诊就诊的患者进行。肝硬化的诊断基于临床检查、实验室参数、超声检查、内镜检查和/或肝活检。在评估排除标准后，招募肝硬化患者进行研究。计算Child Pugh评分和终末期肝病模型评分以评估肝功能。通过静息脉搏、平均动脉压、心电图和二维超声心动图评估心脏功能。
61.9%（48例）出现舒张功能障碍，在酒精性肝病组中更为常见（63.2%对58.6%）。仅6.6%的酒精性肝病患者出现收缩功能障碍。根据2005年世界胃肠病学大会提出的标准，51.4%的患者患有肝硬化性心肌病。79%的患者QTc延长>0.44秒，主要是Child Pugh C级，终末期肝病模型评分>10分。
心脏功能障碍在相当数量的肝硬化患者中普遍存在，尤其是以舒张功能障碍的形式出现，且与病因无关。QTc延长可能是心脏功能障碍的早期指标，并且与Child Pugh评分和终末期肝病模型评分直接相关。
