Solanki Rushil, Sreesh Srijaya, Attumalil Thomas Varghese, Mohapatra Shivabrata Dhal, Narayanan Vijay, Madhu Devika, Chakravorty Avisek, Pal Ravindra, Nair Anjana Nalina Kumari Kesavan, Devadas Krishnadas
Department of Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala (Rushil Solanki, Srijaya Sreesh, Shivabrata dhal Mohapatra, Vijay Narayanan, Devika Madhu, Avisek Chakravorty, Ravindra Pal, Krishnadas Devadas).
Department of Cardiology, CMC Vellore (Thomas Varghese Attumalil).
Ann Gastroenterol. 2023 Nov-Dec;36(6):678-685. doi: 10.20524/aog.2023.0837. Epub 2023 Oct 30.
Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cirrhotic cardiomyopathy. Few studies have addressed its clinical significance in cirrhosis. We assessed the association of LVDD with the factors affecting cirrhosis patients' severity, complications, and survival.
A total of 203 cirrhosis patients were enrolled and underwent investigations, including 2-dimensional echocardiography with tissue Doppler imaging, and 139 patients with LVDD (cases) were compared with 64 patients without LVDD (controls). Logistic regression and Kaplan-Meier analysis were applied.
Mean age was 52.76±10 years. Among LVDD patients, 56% had grade-1, and 44% had grade-2 LVDD. Cirrhosis related to NASH had a more significant association with LVDD (P<0.001) than other etiologies. LVDD was significantly associated with a greater incidence of Child-Turcotte-Pugh (CTP) class C (P<0.001), higher model for end-stage liver disease scores (P=0.001), duration of cirrhosis >2 years since diagnosis (P=0.028), ascites (P<0.001), hepatic encephalopathy (P<0.010), hepatorenal syndrome (P<0.001), and a history of obesity (P=0.004). Multivariate analysis showed that higher CTP score, ascitic fluid protein and prolonged QTc interval were independently associated with LVDD (P=0.009; P=0.018; P=0.016, respectively). Kaplan-Meier survival analysis showed significantly poorer survival status in patients with higher grades of LVDD (P<0.001). The area under the receiver operating characteristic curve (0.78) was greatest for ascitic fluid protein in predicting LVDD, with a cutoff of >1 g/dL.
Higher CTP score, prolonged QTc, higher ascitic fluid protein levels, and poor survival are significantly associated with LVDD. Ascitic fluid protein >1 g/dL could be an indicator for evaluating LVDD.
左心室舒张功能障碍（LVDD）是肝硬化性心肌病的早期表现。很少有研究探讨其在肝硬化中的临床意义。我们评估了LVDD与影响肝硬化患者病情严重程度、并发症及生存的因素之间的关联。
共纳入203例肝硬化患者并进行相关检查，包括二维超声心动图及组织多普勒成像，将139例LVDD患者（病例组）与64例无LVDD患者（对照组）进行比较。应用逻辑回归和Kaplan-Meier分析。
平均年龄为52.76±10岁。在LVDD患者中，56%为1级，44%为2级LVDD。与非酒精性脂肪性肝炎（NASH）相关的肝硬化与LVDD的关联比其他病因更显著（P<0.001）。LVDD与Child-Turcotte-Pugh（CTP）分级C级的发生率更高显著相关（P<0.001），终末期肝病模型评分更高（P=0.001），诊断后肝硬化病程>2年（P=0.028），腹水（P<0.001），肝性脑病（P<0.010），肝肾综合征（P<0.001）以及肥胖史（P=0.004）相关。多因素分析显示，较高的CTP评分、腹水蛋白及延长的QTc间期与LVDD独立相关（分别为P=0.009；P=0.018；P=0.016）。Kaplan-Meier生存分析显示，LVDD分级较高的患者生存状况明显较差（P<0.001）。在预测LVDD方面，腹水蛋白的受试者工作特征曲线下面积（0.78）最大，临界值>1 g/dL。
较高的CTP评分、延长的QTc、较高的腹水蛋白水平及较差的生存与LVDD显著相关。腹水蛋白>1 g/dL可作为评估LVDD的一个指标。
