Functional cardiac abnormalities in cirrhotic patients with and without ascitis

ABSTRACT

Abnormalities in cardiac function have been reported in patients with liver cirrhosis, suggesting latent cardiomyopathic changes in these patients. In this study we investigated cardiac function and morphology in patients with liver cirrhosis with and without ascites. A total of 60 patients with liver cirrhosis [divided into three groups each with 20 patient; group I without ascitis, group II with mild and moderate ascitis and group III with tense ascitis] and 20 normal healthy control subjects were studied by two dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular systolic [ejection fraction, isovolumic contraction time and peak flow velocity of the aortic and pulmonary flow] and diastolic [the peak flow velocity in early diastole E cm/sec, the peak flow velocity in late diastole A cm/sec, and the E/A ratio and the deceleration time of the E wave, the isovolume relaxation time of the left ventricle] functions were evaluated. Our study showed that the EF is significantly low in all patient groups versus the control subjects and in the ascitic patients versus the non-ascitic group [P<0.01] but no significant difference between the patients with mild and moderate ascitis versus the nonascitic patients. The LVET was significantly shorter in patients with tense ascitis [G.3] as compared to non-ascitic patients[G.1] [P0.04]. also the IVCTL/LVET was significantly lower in all patient groups compared to the controls [P<0.006], and in ascitic patients versus non-ascitics[P<0.02]. For the right ventricular systolic function; the VmaxR was significantly decreased in nonascitic patients compared to controls [P<0.03], the RVET was significantly shorter in all patients groups compared to controls [P<0.004]. The E/A ratio was significantly decreased in ascitic patients versus controls [P<0.001 and in ascitics versus nonascitics [P<0.002]. The deceleration time of the E wave was significantly prolonged in ascitic versus controls [P<0.001] and in ascitics versus non-ascitics [P<0.01]. Also, the IVRT was significantly prolonged in all patient groups versus the controls. Both atria and right ventricle were significantly enlarged in cirrhotic patients versus controls and in cirrhotics with ascitis versus those without ascitis. Liver cirrhosis is associated with enlarged right cardiac chambers. Systolic and diastolic dysfunction were evident in cirrhotic patients and more in those with ascites. Our data confirm the presence of cirrhotic cardiomyopathy rather than secondary cardiac adaptation to circulatory changes in liver cirrhosis