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Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension and a normal creatinine.
Hepatology. 2013 May 23;
Authors: Ruíz-Del-Árbol L, Achécar L, Serradilla R, Rodríguez-Gandía MA, Rivero M, Garrido E, Natcher JJ
Abstract
We investigated the left ventricular diastolic dysfunction (LVDD) and its relationship with circulatory function and prognosis in cirrhosis with portal hypertension and normal creatinine. Conventional and Tissue Doppler (TDI) echocardiography, systemic and hepatic hemodynamics and the activity of endogenous vasoactive systems (AEVS) were measured prospectively in 80 patients. Plasma renin activity (PRA)(> 4 ng/mL/h) is used as a surrogate of effective arterial blood volume. Patients were followed-up for 12 months. Thirty-seven patients had LVDD (19 grade-1, 18 grade-2). Left ventricular hypertrophy, left atrial volume, AEVS and natriuretic peptides levels were significantly greater in patients with LVDD than without LVDD. Patients with grade-2 LVDD compared with grade-1 LVDD and without LVDD had significantly lower mean arterial pressure and higher Model for End-Stage Liver Disease (MELD) score, E/e' ratio, cardiopulmonary pressures, PRA and natriuretic peptides levels. Systolic and cardiac chronotropic function were significantly lower in patients with grade-2 LVDD than without LVDD. LVDD was more frequent in patients with ascites and increased PRA than patients without ascites or with ascites but normal PRA. Fourteen patients with LVDD developed hepatorenal syndrome (HRS) Type-1 on follow-up. Survival was different according to degree of LVDD (without LVDD, 95%; grade-1 LVDD, 79%; grade-2 LVDD, 39%; P < 0.001). Independent predictive factors of mortality were MELD score and E/e' ratio. Conclusion: LVDD occurs simultaneously with other changes in cardiac structure and function and is associated to an impairment of effective arterial blood volume. LVDD is a sensitive marker of advanced cirrhosis, type-1 HRS development and mortality. (HEPATOLOGY 2013.).
PMID: 23703953 [PubMed - as supplied by publisher]