Francisco Sampaio1, Joana Pimenta2, Nuno Bettencourt3, Ricardo Fontes-Carvalho4, Ana-Paula Silva5, João Valente6, Paulo Bettencourt7, José Fraga8, Vasco Gama9. 1. Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: fpasampaio@gmail.com. 2. University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: joanamartinspimenta@gmail.com. 3. Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: bettencourt.n@gmail.com. 4. Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal; University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: fontes.carvalho@gmail.com. 5. Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: anapaulasilva1@gmail.com. 6. Internal Medicine Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: jfpvalente@gmail.com. 7. University of Porto Medical School, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal. Electronic address: pbettfer@med.up.pt. 8. Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: jfraga@chvng.min-saude.pt. 9. Cardiology Department, Centro Hospitalar de Gaia/Espinho, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal. Electronic address: ribeiro.vasco@gmail.com.
Abstract
OBJECTIVE: Myocardial dysfunction has been described in patients with cirrhosis and may contribute to haemodynamic disturbances in advanced disease states. However, the prognostic impact of cardiac systolic and diastolic dysfunction in cirrhosis is controversial. We aimed to evaluate the performance of echocardiographic parameters of cardiac function as medium-term prognostic markers, in a cohort of cirrhotic patients. METHODS: Ninety-eight patients (52 discharged after hospitalization for decompensated cirrhosis and 46 ambulatory) were prospectively evaluated. A comprehensive echocardiographic study, including tissue-Doppler and speckle tracking analysis, was performed at baseline. Patients were followed-up for 6 months for the occurrence of death. RESULTS: Twenty patients died during the follow-up. None of the echocardiographic parameters were associated with the occurrence of death. A Child score>10 points (HR 13.1, 95% CI 3.79-45.0, p<0.001) and a mean arterial pressure below the median (HR 3.2, 95% CI 1.14-8.80, p=0.028) were the only independent predictors of mortality in Cox regression multivariate analysis. In previously hospitalized patients, cardiac output, C-reactive protein and albumin levels were associated with 6-month mortality in univariate analysis; this association was lost after adjusting for Child score. CONCLUSIONS: Medium-term mortality in cirrhosis seems to be mainly determined by liver disease severity rather than by myocardial dysfunction. Modern echocardiographic indices of systolic and diastolic function do not seem to be useful in identifying patients at increased risk of dying.
OBJECTIVE:Myocardial dysfunction has been described in patients with cirrhosis and may contribute to haemodynamic disturbances in advanced disease states. However, the prognostic impact of cardiac systolic and diastolic dysfunction in cirrhosis is controversial. We aimed to evaluate the performance of echocardiographic parameters of cardiac function as medium-term prognostic markers, in a cohort of cirrhotic patients. METHODS: Ninety-eight patients (52 discharged after hospitalization for decompensated cirrhosis and 46 ambulatory) were prospectively evaluated. A comprehensive echocardiographic study, including tissue-Doppler and speckle tracking analysis, was performed at baseline. Patients were followed-up for 6 months for the occurrence of death. RESULTS: Twenty patients died during the follow-up. None of the echocardiographic parameters were associated with the occurrence of death. A Child score>10 points (HR 13.1, 95% CI 3.79-45.0, p<0.001) and a mean arterial pressure below the median (HR 3.2, 95% CI 1.14-8.80, p=0.028) were the only independent predictors of mortality in Cox regression multivariate analysis. In previously hospitalized patients, cardiac output, C-reactive protein and albumin levels were associated with 6-month mortality in univariate analysis; this association was lost after adjusting for Child score. CONCLUSIONS: Medium-term mortality in cirrhosis seems to be mainly determined by liver disease severity rather than by myocardial dysfunction. Modern echocardiographic indices of systolic and diastolic function do not seem to be useful in identifying patients at increased risk of dying.
Authors: Achintya D Singh; Andrew Ford; Ruishen Lyu; Habib Layoun; Serge C Harb; Maan Fares; William D Carey Journal: Dig Dis Sci Date: 2022-02-12 Impact factor: 3.487
Authors: Francisco Sampaio; Pablo Lamata; Nuno Bettencourt; Sophie Charlotte Alt; Nuno Ferreira; Johannes Tammo Kowallick; Joana Pimenta; Shelby Kutty; José Fraga; Michael Steinmetz; Paulo Bettencourt; Vasco Gama; Andreas Schuster Journal: J Cardiovasc Magn Reson Date: 2015-07-18 Impact factor: 5.364