von Köckritz Franzisca, Braun Alexander, Schmuck Rosa B, Dobrindt Eva M, Eurich Dennis, Heinzel Frank R, Pieske Burkert, Escher Felicitas, Zhang Kun
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. 2021 Feb 24;10(5):897. doi: 10.3390/jcm10050897.
Cardiac function can be influenced by liver cirrhosis and should be thoroughly evaluated before liver transplantation. We investigated left ventricular (LV) and, for the first time, left atrial (LA) strain and strain rate in end-stage liver cirrhosis patients of different etiologies.
This retrospective, cross-sectional study evaluated left heart function in 80 cirrhosis patients and 30 controls using standardized echocardiographic techniques and speckle tracking technology (STE) analysis. Serum markers of liver function were used for correlation analysis.
While conventional parameters demonstrated no alteration in systolic function, speckle tracking analysis showed a significant increase in LV longitudinal strain throughout all cardiac layers, with significant correlation to model of end-stage liver disease (MELD) score. LA reservoir and conduit strain as well as LA strain rate in all phases were significantly reduced in end-stage liver disease (ESLD) patients compared to control. STE for the evaluation of LA phasic function seemed to be more sensitive than volumetric methods. Kaplan-Meier curves showed a trend towards reduced post-transplant survival in patients with a reduced LA reservoir and conduit strain.
STE analysis detected increased LV and decreased LA deformation in cirrhosis patients, thus proving to be highly sensitive to cardiac changes and useful for more precise cardiac evaluation.
心脏功能会受到肝硬化的影响，在肝移植前应进行全面评估。我们首次研究了不同病因的终末期肝硬化患者的左心室（LV）以及左心房（LA）应变和应变率。
这项回顾性横断面研究使用标准化超声心动图技术和斑点追踪技术（STE）分析评估了80例肝硬化患者和30例对照者的左心功能。使用肝功能血清标志物进行相关性分析。
虽然传统参数显示收缩功能无改变，但斑点追踪分析显示所有心肌层的左心室纵向应变均显著增加，且与终末期肝病模型（MELD）评分显著相关。与对照组相比，终末期肝病（ESLD）患者的左心房储存和管道应变以及各阶段的左心房应变率均显著降低。用于评估左心房阶段性功能的STE似乎比容积法更敏感。Kaplan-Meier曲线显示，左心房储存和管道应变降低的患者移植后生存率有降低趋势。
STE分析检测到肝硬化患者左心室变形增加，左心房变形减少，因此证明对心脏变化高度敏感，有助于更精确的心脏评估。
