Clinical and Experimental Cardiology Research

Biography

Biography: Kusztal Maciej

Abstract

Background/Introduction: Cirrhotic cardiomyopathy (CCM) is a condition concerning heart muscle dysfunction, occurring among

patients with cirrhosis. Cirrhosis leads to the development of a hyperdynamic syndrome, which is

manifested by high cardiac output, increased heart rate and effective arterial blood volume,

accompanied by reduced total systemic vascular resistance.

    Purpose: The aim of the study is to screen patients with cirrhosis, which may lead to earlier diagnosing CCM and hyperdynamic syndrome with its consequences among them.

    Methods: The study included 70 patients over 18 years old, with cirrhosis, caused by alcohol ([ALD], 22),

autoimmune (26), viral (9) other reasons (13), qualified for liver transplantation. 39 of them were

male. Median age was 47. We disqualified patients with a history of cardiovascular diseases. Each

patient had a 6-minute walking test (6MWT) done and a hemodynamic monitoring using non-invasive hemodynamic monitor device was also performed.

    Results: Basic group characteristic differs between aetiologies of liver diseases. Median NTproBNP level was highest in ALD group (253pg/ml) and viral group (177,5 pg/ul) compared to autoimmune group (51

pg/ul) and other (114 pg/ml). Median QTc interval was more prolonged in patients with viral

aetiology (456ms) and ALD aetiology (441ms) than autoimmune aetiology (422ms) and other

aetiology (431ms). Highest median CO were observed in viral group (6L/min) and ALD group

(5,7L/min) and lower in autoimmune group (5,35L/min) and other (5,2L/min). Median SVRI was

lowest in viral aetiology (1700 dyn- s/cm –5 /m 2 ) and ALD aetiology (1888 dyn- s/cm –5 /m 2 ) and higher

in autoimmune aetiology (2067 dyn- s/cm –5 /m 2 ) and other aetiology (2432 dyn- s/cm –5 /m 2 ).

There was no statistical difference in distance median value between aetiological groups (407m in

ALD patients’ group, 412,5m in autoimmune patients’ group, 384m in viral patients’ group and 400m

for other aetiology patients’ group; p=NS). The haemodynamic parameters (CO, SV, SVRI) were not

correlated with MELD score and Child Pugh score (p=NS). DBP was positively correlated with MELD

score (r=-0,25; p=0,009) and Child-Pugh score (r=-0,31; p=0,003). The distance was negatively

corelated with severity of the liver disease based on MELD score (r=-0,34; p=0,0048) score and Child-

Pugh score (r=-0,321 ; p=0,0072).Preliminary results show statistically significant correlations

between distance in 6MWT and eGFR (r=0,78;p=0,0082), Systemic Vascular Resistance(SVR) at the

end of 6MWT (r=0,197 ;p=0,0011), Diastolic Blood Pressure (DBP) at the end of 6MWT

(r=0,45;p=0,014) and NT-proBNP (r=0,28 ;p=0,0008) level, patient’s weight (r=0,286; p=0,044) and

height (r=0,37; p=0,008).

    Conclusion(s): Preliminary results show that we can detect subclinical alterations in patients’ circulatory parameters by non-invasive haemodynamic monitoring. In our study patients with viral and ALD etiology

presented more advanced liver cirrhosis stages and more pronounced manifestations of

hyperdynamic syndrome which may later progress to CCM. Positive correlation of liver cirrhosis stage

and NTproBNP, QTc and 6MWT distance may suggest heart function impairment in course of liver

disease.