Torre DA, Castillo ML, Orea TA, Rebollar GV, Olivera MM, Jiménez DV, Hernandez RD, Hernandez GT, Kershenobich SD

Language: Spanish
References: 44
Page: 197-202
PDF size: 216.81 Kb.

ABSTRACT

Background: Cardiopulmonary abnormalities are frequent in patients with advanced stages of liver and lung diseases. Several studies have shown some degree of increased ventricular wall thickness, diastolic dysfunction, and abnormal systolic response to stress, without any relation to the etiology of the hepatic disease.
Objective: To know the echocardiographic profile of patients with hepatic cirrhosis and its relation with the etiology, the Child-Pugh classification and the hepatopulmonary syndrome frequency.
Patients and method: 120 patients with liver disease were consecutively included in four groups of 30 patients each one: alcoholic-nutritional hepatic cirrhosis, primary biliary cirrhosis, autoimmune cirrhosis, and post-necrotic cirrhosis. They were divided accordingly to the Child-Pugh classification. A contrast echocardiogram was obtained in all cases.
Results: An increase in the end systolic diameter “E” wave-interventricular septum distance of the left ventricle and the higher mitral valve opening correlated with the worst functional Child-Pugh classification. In alcoholic nutritional hepatic cirrhosis we found the biggest left ventricle end systolic dimensions, as well as right ventricle diastolic diameter and right/left ventricle rate. Hepatopulmonary syndrome was found in 20 patients (16.7%).
Conclusion: Right cardiac chamber enlarged in cirrhosis is probably the consequence of an increased preload. Left ventricle ejection fraction at rest is preserved, however, the increased left ventricle end systolic diameter could mean a reduction of the contractile reserve, as can be observed in our cases.

REFERENCES

1. Bosch J, Pizcueta P, Feu F, Fernández M, García-Pagán JC. Pathophysiolgy of portal hypertension. Gastroenterol Clin North Am 1992;21:1-14.

2. Ma Z, Lee SS. Cirrhotic cardiomyopathy: getting to the heart of the matter. Hepatology 1996;24:451-9.

3. Moller S, Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart 2002;87:9-15.

4. Torregrosa M, Aguade S, Dos L, Segura R, et al. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol 2005;42(1):68-74.

5. Grose RD, Nolan J, Dillon JF, Errington M, et al. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis. J Hepatol 1995;22:326-32.

6. Fluckiger M. Vokommen von trommelschagel formigen fingerendphalangen ohne chronische veranderungen an der lungen oder am Herzen. Wien Med Wochenschr 1884;34:1457.

7. Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly 2003;133:163-9.

8. Rubin LJ, Roux S. Bosentan: a dual endothelin receptor antagonist. Expert Opin Investig Drugs 2002;11:991-1002.

9. Rodríguez-Roisin R, Roca J, Agusti AG, Mastai R, et al. Gas exchange and pulmonary vascular reactivity in patients with liver cirrhosis. Am Rev Respir Dis 1987;135:1085-92.

10. Mal H, Burgiere O, Durand F, Fartoukh M, et al. Pulmonary hypertension following hepatopulmonar syndrome in a patient with cirrhoss. J Hepatol 1999;31:360-4.

11. Schenk P, Fuhrmann V, Madl C, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002;51:853-9.

12. Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome: clinical observations and lack of therapeutic response to somatostatin analogue. Chest 1993;104:515-21.

13. Vachiery F, Moreau R, Hadengue A, et al. Hypoxemia in patients with cirrhosis: relationship with liver failure and hemodynamic alterations. J Hepatol 1997;27:492-5.

14. Caruso G, Catalano D. Esophageal varices and hepato-pulmonary syndrome in liver cirrhosis. J Hepatol 1991;12:262-3.

15. Lange PA, Stoller JK. The hepatopulmonary syndrome. Ann Intern Med 1995;122:521-9.

16. Rodríguez-Roisin R. The hepatopulmonary syndrome: new name, old complexities (editorial). Thorax 1992;47:897-902.

17. Kim WR, Krowka MJ, Plevak DJ, et al. Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl 2000;6:453-8.

18. Torregrosa M, Genesca J, González A, et al. Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. Transplantation 2001;71:572-4.

19. Colle IO, Moreau R, Godinho E, et al. Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study. Hepatology 2003;37:401-9.

20. McAdams HP, Erasmus J, Crockett R, Mitchell J, et al. The hepatopulmonary syndrome: radiologic findings in 10 patients. AJR Am J Roentgenol 1996;166:1379-85.

21. Schenk P, Madl C. Methylene blue improves the hepatopulmonary syndrome. Ann Intern Med 2000;133(9):701-6.

22. Herve P, Lebrec D. Pulmonary vascular disorders in portal hypertension. Eur Respir J 1998;11:1153-66.

23. Abrams GA, Fallon MB. Treatment of hepatopulmonary syndrome with Allium sativum (garlic). J Clin Gastroenterol 1998;27:232-5.

24. Shijo H, Sasaki H, Yuh K, et al. Effects of indomethacin on hepatogenic pulmonary angiodysplasia. Chest 1991;99:1027-9.

25. Abrams GA, Jaffe CC, Hoffer PB, et al. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995;109:1283-8.

26. Aller R, Moya JL, Moreira V, et al. Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography. Dig Dis Sci 1999;44:1243-8.

27. Rolla G, Brussino L. Exhaled nitric oxide and impaired oxygenation in cirrhotic patients before and after liver transplantation. Ann Intern Med 1998;129:375-8.

28. Naschitz J, Slobodin G, Lewis R, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J 2000;140:111-20.

29. Krowka MJ, Cortese DA. Hepatopulmonary syndrome: an evolving perspective in the era of liver transplantation. Hepatology 1990;11:138-42.

30. Krowka MJ, Porayko MK, Plevak DJ, et al. Hepatopulmonary syndrome with progressive hypoxemia as an indication for liver transplantation: case reports and literature review. Mayo Clin Proc 1997;72:44-53.

31. Liu H, Lee SS. Cardiopulmonary dysfunction in cirrhosis. J Gastroenterol Hepatol 1999;14:600-8.

32. Ma A, Lee SS. Cirrhotic cardiomyopathy: getting to the heart of the matter. Hepatology 1996;24:451-9.

33. Binah OS, Bomzon A, Blendis LM, Mordechowitz D, Better OS. Obstructive jaundice blunts myocardical contractile response to isoprenalina in the dog: a clue to susceptibility of jaundiced patients to shock? Clin Sci 1985;69:647-53.

34. Ballingand JL, Kelly RA, Marsden PA, Smith TW, Michel T. Control of cardiac muscle cell function by an endogenous nitric oxide signaling system. Proc Natl Acad Sci USA 1993;90:347-51.

35. Bomzon A, Blendis LM. The nitric oxide hypothesis and the hyperdynamic circulation in cirrhosis. Hepatology 1994;20:1343-50.

36. Battista S, Bar F, Mengozzi G, Zanon E, et al. Hyperdynamic circulation in patients with cirrhosis: direct measurement of nitric oxide levels in hepatic and portal veins. J Hepatol 1997;26:75-80.

37. Sogni P, Smith AP, Gadano A, Lebrec D, Higenbottam TW. Induction of nitric oxide synthase II does not account for excess vascular nitric oxide production in experimental cirrhosis. J Hepatol 1999;26:1120-7.

38. Jiménez W, Arroyo V. Origins of cardiac dysfunction in cirrhosis. Gut 2003;52:1392-4.

39. Del Gercio LRM, Commaraswamy RP, Fénix NR, et al. Pulmonary arteriovenous admixture and the hyperdynamic cardiovascular state in surgery for portal hypertension. Surgery 1964;56:57-74.

40. Johnson G, Dart CH, Peters RM, et al. Hemodynamic changes with cirrhosis of the liver: control of arteriovenous shunts during operation for esophageal varices. Ann Surg 1996;163:692-703.

41. Braillon A, Gaudin C, Poo JL, Moreau R, et al. Plasma catecholamine concentrations are a reliable index of sympathetic vascular tone in patients with cirrhosis. Hepatology 1992;15:58-62.

42. Henriksen JH, Gotze JP, Fuglsang S, Christensen E, et al. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut 2003;52:1511-7.

43. Valeriano V, Funaro S, Lionetti R, Riggio O, et al. Modification of cardiac function in cirrhotic patients with and without ascites. Am J Gastroenterol 2000;95:3200-5.

44. Sherlock S. The liver in circulatory failure. In: Schiff L, Schiff ER, editors. Diseases of the liver. 7th ed. Philadelphia: JB Lippincott, 1993;p:1431.