Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology, Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
Department of Internal Medicine and Cardiology (IMuK), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
Liver Int. 2021 May;41(5):1058-1069. doi: 10.1111/liv.14769. Epub 2021 Jan 2.
Recently published criteria by 2019 Cirrhotic Cardiomyopathy Consortium set a lower threshold for reduced ejection fraction to diagnose systolic dysfunction in cirrhotic patients, and stress testing was replaced by echocardiography strain imaging. The criteria to diagnose diastolic dysfunction are in general concordant with the 2016 ASE/EACVI guidelines and differ considerably from the 2005 Montreal recommendations. We aimed to assess the prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria.
Cirrhotic patients without another structural heart disease, arterial hypertension, portal vein thrombosis, HCC outside Milan criteria and presence of TIPS were enrolled. Speckle-tracking echocardiography was performed by EACVI certified investigators.
A total of 122 patients with cirrhosis fulfilled the inclusion criteria. Overall prevalence of cirrhotic cardiomyopathy was similar for 2005 Montreal and 2019 CCC: 67.2% vs 55.7% (P = .09); and significantly higher compared to 2009 ASE/EACVI criteria: 67.2% vs 35.2% (P < .0001) and 55.7% vs 35.2% (P = .002) respectively. Significantly more patients had diastolic dysfunction according to the 2005 Montreal compared to the 2009 ASE/EACVI and 2019 CCC criteria: 64.8% vs 32.8% (P < .0001) and 64.8% vs 7.4% (P < .0001). Systolic dysfunction was more frequently diagnosed according to 2019 CCC criteria compared to 2005 Montreal (53.3% vs 16.4%,P < .0001) or ASE/EACVI criteria (53.3% vs 4.9%,P < .0001).
Cirrhotic cardiomyopathy was present in around 60% of cirrhotic patients when applying the hepatological criteria. A considerably higher prevalence of systolic dysfunction according to the 2019 CCC criteria was observed. Long-term follow-up studies are needed to establish the validity of these criteria to predict clinically relevant outcomes.
最近由 2019 年肝硬化心肌病联盟发布的标准为诊断肝硬化患者收缩功能障碍设定了更低的射血分数阈值，并以超声心动图应变成像取代了应激测试。舒张功能障碍的诊断标准与 2016 年 ASE/EACVI 指南基本一致，与 2005 年的蒙特利尔建议有很大不同。我们旨在根据不同的诊断标准评估肝硬化心肌病的患病率。
纳入无其他结构性心脏病、动脉高血压、门静脉血栓形成、米兰标准外的 HCC 和 TIPS 的肝硬化患者。EACVI 认证的研究人员进行斑点追踪超声心动图检查。
共有 122 名符合纳入标准的肝硬化患者。2005 年蒙特利尔和 2019 年 CCC 的肝硬化心肌病总患病率相似：67.2%比 55.7%（P=0.09）；与 2009 年 ASE/EACVI 标准相比显著升高：67.2%比 35.2%（P<0.0001）和 55.7%比 35.2%（P=0.002）。根据 2005 年的蒙特利尔标准，有更多的患者存在舒张功能障碍，与 2009 年 ASE/EACVI 和 2019 年 CCC 标准相比：64.8%比 32.8%（P<0.0001）和 64.8%比 7.4%（P<0.0001）。与 2005 年的蒙特利尔标准相比，2019 年 CCC 标准更频繁地诊断出收缩功能障碍（53.3%比 16.4%，P<0.0001）或 ASE/EACVI 标准（53.3%比 4.9%，P<0.0001）。
应用肝病学标准时，约 60%的肝硬化患者存在肝硬化心肌病。根据 2019 年 CCC 标准，观察到收缩功能障碍的发病率明显更高。需要进行长期随访研究，以确定这些标准预测临床相关结局的有效性。
