BACKGROUND: Morphological and functional cardiac modifications attributable to neurohumoral activation and hyperdynamic circulation have been found in patients with liver cirrhosis (LC). Cardiovagal baroreflex sensitivity (BRS) has been shown to inversely correlate with left ventricular (LV) morphology. It was hypothesized that, in patients with cirrhotic cardiomyopathy, reduced BRS is associated with myocardial remodeling and increased LV mass index (LVMI). METHODS AND RESULTS: Eighty-two LC patients scheduled to undergo liver transplantation were evaluated. Spectral analysis was done of beat-by-beat blood pressure and heart rate (HR) time series and BRS was derived from their cross-spectral gain. Echocardiography before liver transplantation was used to evaluate heart morphology and function. BRS was inversely correlated with LV wall thickness (P=0.038), end-diastolic interventricular septum thickness (P=0.048), LVMI (P=0.005) and HR (P<0.001). On multivariate stepwise linear analysis LVMI and HR were independently associated with BRS. On tertile analysis of LVMI, compared with the lowest tertile of LVMI (75±11 g/m(2)), the highest tertile (118±13 g/m(2)) showed significantly impaired BRS (4.6±2.3 vs. 6.4±3.1 ms/mmHg, P=0.012). CONCLUSIONS: Reduced cardiovagal BRS is associated with increased LV mass in patients with LC, suggesting a relationship between cardiovagal BRS control of HR and cardiac end-organ damage in patients with cirrhotic cardiomyopathy.
BACKGROUND: Morphological and functional cardiac modifications attributable to neurohumoral activation and hyperdynamic circulation have been found in patients with liver cirrhosis (LC). Cardiovagal baroreflex sensitivity (BRS) has been shown to inversely correlate with left ventricular (LV) morphology. It was hypothesized that, in patients with cirrhotic cardiomyopathy, reduced BRS is associated with myocardial remodeling and increased LV mass index (LVMI). METHODS AND RESULTS: Eighty-two LC patients scheduled to undergo liver transplantation were evaluated. Spectral analysis was done of beat-by-beat blood pressure and heart rate (HR) time series and BRS was derived from their cross-spectral gain. Echocardiography before liver transplantation was used to evaluate heart morphology and function. BRS was inversely correlated with LV wall thickness (P=0.038), end-diastolic interventricular septum thickness (P=0.048), LVMI (P=0.005) and HR (P<0.001). On multivariate stepwise linear analysis LVMI and HR were independently associated with BRS. On tertile analysis of LVMI, compared with the lowest tertile of LVMI (75±11 g/m(2)), the highest tertile (118±13 g/m(2)) showed significantly impaired BRS (4.6±2.3 vs. 6.4±3.1 ms/mmHg, P=0.012). CONCLUSIONS: Reduced cardiovagal BRS is associated with increased LV mass in patients with LC, suggesting a relationship between cardiovagal BRS control of HR and cardiac end-organ damage in patients with cirrhotic cardiomyopathy.