Dash Subhash Chandra, Rajesh Beeravelli, Behera Suresh Kumar, Sundaray Naba Kishore, Patil Praveen
Department of General Medicine, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India.
Department of General Medicine, Chalmeda Ananda Rao Institute of Medical Sciences, Telangana, India.
Rambam Maimonides Med J. 2023 Jan 29;14(1):e0001. doi: 10.5041/RMMJ.10488.
Cirrhotic cardiomyopathy (CCM) is associated with increased morbidity and mortality in patients with liver cirrhosis. Yet, it remains an under-diagnosed entity. Further, its relation to the severity of cirrhosis is contradictory. We conducted this study on an Indian population to determine the cardiac dysfunctions in cirrhosis of the liver and correlations with etiologies and cirrhosis severity.
This study enrolled patients with diagnosed liver cirrhosis without any cardiac disease or conditions affecting cardiac function. All participants were evaluated clinically, electrocardiographically, and echocardiographically. Cirrhosis severity was assessed by scores from the Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) tests. Cirrhotic cardiomyopathy was defined as diastolic dysfunction and/or systolic dysfunction with QT prolongation.
Ninety-six patients were evaluated, and CTP-A stage of cirrhosis was found in 23 (24%), CTP-B in 42 (43.8%), and CTP-C in 31 (32.3%) cases. Systolic dysfunction was most frequent (P=0.014), and left ventricular ejection fraction was significantly reduced (P=0.001) in CTP-C stage of cirrhosis. Cirrhotic cardiomyopathy was found in 39.6% (n=38) of patients; CCM patients had significantly higher CTP scores (9.6±2.6 versus 8.3±2.3, P=0.012) as well as MELD scores (19.72±4.9 versus 17.41±4.1, P=0.015) in comparison to patients without CCM.
Cirrhotic cardiomyopathy has a positive relationship with the severity of cirrhosis. Systolic function declines with the severity of cirrhosis, and overt systolic dysfunction can be present, particularly in the advanced stage of cirrhosis of the liver.
肝硬化性心肌病（CCM）与肝硬化患者发病率和死亡率的增加相关。然而，它仍是一个诊断不足的病症。此外，其与肝硬化严重程度的关系存在矛盾。我们在印度人群中开展了这项研究，以确定肝硬化患者的心脏功能障碍及其与病因和肝硬化严重程度的相关性。
本研究纳入了确诊为肝硬化且无任何心脏病或影响心脏功能疾病的患者。所有参与者均接受了临床、心电图和超声心动图评估。通过终末期肝病模型（MELD）和Child-Turcotte-Pugh（CTP）试验的评分评估肝硬化的严重程度。肝硬化性心肌病定义为舒张功能障碍和/或伴有QT延长的收缩功能障碍。
共评估了96例患者，其中23例（24%）为CTP-A期肝硬化，42例（43.8%）为CTP-B期，31例（32.3%）为CTP-C期。收缩功能障碍最为常见（P=0.014），在CTP-C期肝硬化患者中左心室射血分数显著降低（P=0.001）。39.6%（n=38）的患者被发现患有肝硬化性心肌病；与无CCM的患者相比，CCM患者的CTP评分（9.6±2.6对8.3±2.3，P=0.012）以及MELD评分（19.72±4.9对17.41±4.1，P=0.015）显著更高。
肝硬化性心肌病与肝硬化的严重程度呈正相关。收缩功能随肝硬化严重程度下降，且可能出现明显的收缩功能障碍，尤其是在肝硬化晚期。
