Document Detail

Left Ventricular Function Assessed by Echocardiography in Cirrhosis. Relationship to Systemic Hemodynamics and Renal Dysfunction.
MedLine Citation:
PMID:  22989573     Owner:  NLM     Status:  Publisher    
BACKGROUND AND AIMS: The current study was aimed to assess the potential role of cardiac abnormalities in the pathogenesis of circulatory and renal dysfunction in cirrhosis. METHODS: One hundred and fifty two patients (34 without ascites, 95 with ascites without renal failure and 21 with hepatorenal syndrome) were evaluated using Doppler Echocardiography. In 102 patients diastolic function was assessed by measuring parameters related to ventricular filling velocity, mitral annulus velocity and left atrial dimensions. Cardiopulmonary pressures were also measured by cardiac catheterization in 54 patients. In 50 additional patients left ventricular myocardial strain was performed to estimate myocardial contractility and systolic function. RESULTS: Grade 1 and 2 diastolic dysfunction was present in 41% and 16% of patients, respectively. There was no patient with severe grade 3 diastolic dysfunction. Grade 2 diastolic dysfunction was associated to higher cardiopulmonary pressures but values were within the normal limits in all cases. Diastolic dysfunction directly correlated with liver failure but not with the degree of impairment in circulatory and renal function. The proportion of patients without or with grade 1 or 2 diastolic dysfunction was similar in patients with compensated cirrhosis, with ascites without renal failure or with hepatorenal syndrome despite marked differences in the degree of circulatory dysfunction as indicated by plasma renin activity and noradrenaline concentration. The heart rate and systolic function were normal in all cases. There being also no differences between patients without ascites, with ascites without renal failure or with HRS despite marked differences in the activity of the renin-angiotensin system and sympathetic nervous system. These features indicate an impaired response of cardiac chronotropic and inotropic function to changes in systemic hemodynamics. CONCLUSION: These data indicates: 1) Diastolic dysfunction is frequent in cirrhosis but in most cases it is of mild degree and does not increase cardiopulmonary pressure to abnormal levels. This feature, which may be due to the central hypovolemia of cirrhosis, probably accounts for the lack of symptoms associated to this condition. 2) Diastolic dysfunction in cirrhosis is unrelated to circulatory dysfunction, ascites and HRS. 3). In cirrhosis there is a lack of response of the left ventricular systolic and chronotropic function to peripheral arterial vasodilation and activation of the sympathetic nervous system and this feature is an important contributory factor to the progression of circulatory dysfunction, and the pathogenesis of ascites and HRS.
André Nazar; Mónica Guevara; Marta Sitges; Carlos Terra; Elsa Solà; Carina Guigou; Vicente Arroyo; Pere Ginès
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-15
Journal Detail:
Title:  Journal of hepatology     Volume:  -     ISSN:  1600-0641     ISO Abbreviation:  J. Hepatol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
Liver Unit, Institut del Torax. Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Instituto Reina Sofía de Investigación Nefrológica (IRSIN). Mónica Guevara and André Nazar contribuited equally in the manuscript.
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