Study of the prognostic value of early echocardiographic assessment of left ventricular function in acute variceal bleeding

ABSTRACT

To determine the prognostic value of early echocardiographic assessment in patients with acute variceal bleeding. The study was conducted on 80 patients with portal hypertension, admitted to the emergency hematemesis and tropical medicine units at the Alexandria University main Hospital. They were divided into two groups; group I included 40 patients with acute variceal hemorrhage and group II included 40 patients without active bleeding. Transthoracic echocardiography was used to measure and calculate left ventricular fractional shorting, left ventricular ejection fraction, stroke volume, cardiac output, total peripheral vascular resistance and the left venticular stoke work. According to the inhospital course; the bleeders [group I] were further subdivided into two subgroups group la included 16 [40%] patients who had a poor evolution [inhospital mortality or early variceal rebleeding], and group Ib included 24 [60%] patients were discharged uneventfully. Using standard univariate analysis, the poorly evoluted patients had lower stroke volume [64.44 +/- 13.25vs. 82.33 +/- 15.88ml/beat, p=0.017], lesser cardiac index [3.10 +/- 0.66vs. 4.48 +/- 0.69L/min/[m]2, p=0.007], higher systemic vascular resistance [1387 +/- 379vs. 990 +/- 239dynes/sec/[cm]-5,p=0.010] and lower left ventricular stroke work [77.94 +/- 13.34vs. 104.18 +/- 23gram-m; p=0.007]. The prognostic value of such four variables was tested by running a stepwise logistic regression analysis. The cardiac index was the only significant predictor factor for poor evolution among our patients [chi square = 13.78, P=0.002]. The resting cardiac index is a useful predictor for inhospital mortality among patients with portal hypertension and acute variceal bleeding. Echocardiographic measurement of the cardiac index and the systemic vascular resistance may help to identify the high risk bleeders to optimise their management