Department of Cardiovascular Medicine.
Department of Ultrasound.
Am J Cardiol. 2023 Dec 1;208:180-189. doi: 10.1016/j.amjcard.2023.09.069. Epub 2023 Oct 16.
The comparison between the diagnostic criteria for cirrhotic cardiomyopathy (CCM) first proposed in 2005 (2005 Montreal criteria), and those redefined in the 2019 Cirrhotic Cardiomyopathy Consortium (2019 CCC criteria) has generated significant controversy. Importantly, the predictive value of these criteria in cirrhotic patients (CPs) remains unclear to this date. Thus, the present study aims to compare the 2 sets of criteria and investigate their predictive value in CPs. Between April 2021 and April 2023, a total of 104 CPs with an average age of 46.4 ± 8.9 years, who had no history of other cardiac diseases or malignancies were enrolled in this prospective single-center observational cohort study, conducted at the Third Affiliated Hospital of Sun Yat-Sen University. Various echocardiographic indicators were measured and assessed for their prognostic value and association with clinical outcomes. The prevalence of CCM was found to be comparable when evaluated using both the 2019 CCC and 2005 Montreal criteria (54.8% vs 44.2%, p = 0.161). However, the diagnosis of systolic dysfunction was significantly different between the 2 criteria (52.9% vs 1.0%, p <0.001). Among patients with systolic dysfunction, 27.9% had reduced left ventricular global longitudinal strain, while 25% had increased left ventricular global longitudinal strain. Moreover, fewer patients were diagnosed with diastolic dysfunction (DD) using the 2019 CCC criteria (4.8% vs 44.2%, p <0.001). Multivariate Cox analysis revealed that CPs who had encephalopathy, a high model for end-stage liver disease score, and DD diagnosed using the 2019 CCC criteria exhibited a poorer prognosis. In conclusion, although the prevalence of CCM according to both criteria is similar, the consistency is poor, indicating that they are not the same group of patients. Importantly, CPs with DD diagnosed according to the 2019 CCC criteria might be associated with increased adverse events.
2005 年首次提出的肝硬化心肌病（CCM）诊断标准（2005 年蒙特利尔标准）与 2019 年肝硬化心肌病联盟（2019 年 CCC 标准）重新定义的标准之间的比较引起了很大争议。重要的是，这些标准在肝硬化患者（CPs）中的预测价值迄今仍不清楚。因此，本研究旨在比较这两组标准，并研究它们在 CPs 中的预测价值。2021 年 4 月至 2023 年 4 月，共纳入 104 例平均年龄为 46.4±8.9 岁、无其他心脏疾病或恶性肿瘤病史的 CPs，进行了前瞻性单中心观察队列研究，在中山大学附属第三医院进行。测量了各种超声心动图指标，并评估了它们的预后价值和与临床结局的关系。使用 2019 年 CCC 和 2005 年蒙特利尔标准评估时，CCM 的患病率相似（54.8%比 44.2%，p=0.161）。然而，两种标准之间的收缩功能障碍诊断有显著差异（52.9%比 1.0%，p<0.001）。在收缩功能障碍患者中，27.9%的患者左心室整体纵向应变降低，25%的患者左心室整体纵向应变增加。此外，使用 2019 年 CCC 标准诊断的舒张功能障碍（DD）患者较少（4.8%比 44.2%，p<0.001）。多变量 Cox 分析显示，有脑病、终末期肝病模型评分高和使用 2019 年 CCC 标准诊断为 DD 的 CPs 预后较差。总之，尽管根据两种标准诊断的 CCM 患病率相似，但一致性较差，表明它们不是同一组患者。重要的是，根据 2019 年 CCC 标准诊断为 DD 的 CPs 可能与不良事件增加有关。
