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2020, Number 1

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CorSalud 2020; 12 (1)

Cardiovascular manifestations of liver cirrhosis according to its severity evaluated through the Child-Pugh score

Pérez BA, Hernández AE, Pérez GT, Samada SM, Hernández PJC, Puig FMJ, Ravelo LK, Alfonso MOA

Language: English
References: 62
Page: 20-30
PDF size: 670.08 Kb.


ABSTRACT

Introduction: Cirrhotic cardiomyopathy is a cardiac dysfunction that is present in patients with liver cirrhosis, in the absence of other heart disease.
Objectives: To ascertain electrocardiographic and echocardiographic findings and arterial oxygenation state in patients with liver cirrhosis. Methods: An observational, descriptive, cross-sectional stu
dy was conducted with 95 liver transplant recipients at the CIMEQ over the established period. The ChildPug severity classification was applied for this purpose.
Results: We screened 95 patients (53 women [55.7%]) who underwent electrocardiography, echocardiography, and determination of blood oxygen pressure and oxygen saturation by oximetry. The SPSS (20), with summary measures for qualitative (ratios and percentages) and quantitative (mean and standard deviation) variables was used. Our results reveal greater compromise of the variables studied in correlation with a greater severity of liver cirrhosis, as assessed by ChildPugh, in relation to S' wave (p=0.03), A wave (p=0.03), pulmonary artery systolic pressure (p=0.004) and arterial oxygen partial pressure (p=0.004).
Conclusions: Taking into account the Child-Pugh score, study showed a progressive approach to pathological values of echocardiographic variables for the analysis of diastolic function and pulmonary pressures, as well as oxygen content of arterial blood (PaO2), in the most advanced stages of liver cirrhosis.


REFERENCES

  1. World Health Organization. World Health Statis-tics 2011. Geneva: WHO Press [Internet]; 2011 [ci-tado 27 Abr 2019]. Disponible en: https://www.who.int/gho/publications/world_health_statistics/2011/en/

  2. Ministerio de Salud Pública. Anuario Estadístico de Salud 2018. La Habana: Dirección de Registros Médicos y Estadísticas de Salud; 2019.

  3. Poordad FF. Presentation and complications as-sociated with cirrhosis of the liver. Curr Med Res Opin. 2015;31(5):925-37.

  4. Kowalski HJ, Abelmann WH. The cardiac output at rest in Laennec's cirrhosis. J Clin Invest. 1953; 32(10):1025-33.

  5. Møller S, Lee SS. Cirrhotic cardiomyopathy. J Hepatol. 2018;69(4):958-60.

  6. Krowka MJ. Portopulmonary hypertension. Semin Respir Crit Care Med. 2012;33(1):17-25.

  7. Voiosu AM, Daha IC, Voiosu TA, Mateescu BR, Dan GA, Băicuş CR, et al. Prevalence and impact on survival of hepatopulmonary syndrome and cirrhotic cardiomyopathy in a cohort of cirrhotic patients. Liver Int. 2015;35(12):2547-55.

  8. Karagiannakis DS, Papatheodoridis G, Vlachogi-annakos J. Recent advances in cirrhotic cardio-myopathy. Dig Dis Sci. 2015;60(5):1141-51.

  9. Gassanov N, Caglayan E, Semmo N, Massenkeil G, Er F. Cirrhotic cardiomyopathy: a cardiologist's perspective. World J Gastroenterol. 2014;20(42): 15492-8.

  10. Van Wagner LB, Serper M, Kang R, Levitsky J, Hohmann S, Abecassis M, Skaro A, Lloyd-Jones DM. Factors associated with major adverse car-diovascular events after liver transplantation among a national sample. Am J Transplant. 2016; 16(9):2684-94.

  11. Pudil R, Pelouch R, Praus R, Vašatová M, Hůlekc P. Heart failure in patients with liver cirrhosis. Cor et Vasa [Internet]. 2013 [28 Abr 2019];55(4): e391-e396. Disponible en: https://doi.org/10.1016/j.crvasa.2013.06.002

  12. Polavarapu N, Tripathi D. Liver in cardiopulmo-nary disease. Best Pract Res Clin Gastroenterol. 2013;27(4):497-512.

  13. Kamath PS. Portopulmonary hypertension and hepatopulmonary syndrome. J Gastroenterol Hepatol. 2002;17(Supl 3):S253-5.

  14. Porres-Aguilar M, Gallegos-Orozco JF, Garcia H, Aguirre J, Macias-Rodriguez RU, Torre-Delgadillo A. Complicaciones vasculares pulmonares en hi-pertensión pulmonar y enfermedades hepáticas: una revisión concisa. Rev Gastroenterol Mex. 2013;78(1):35-44.

  15. Karagiannakis DS, Vlachogiannakos J, Anastasia-dis G, Vafiadis-Zouboulis I, Ladas SD. Diastolic cardiac dysfunction is a predictor of dismal prog-nosis in patients with liver cirrhosis. Hepatol Int. 2014;8(4):588-94.

  16. Marchetta S, Delwaide J, Lancellotti R. La cardi-omyopathie du cirrhotique: un bref apercu [Cir-rhotic cardiomyopathy: a brief overview]. Rev Med Liege. 2015;70(2):86-91.

  17. Raevens S, Colle I, Reyntjens K, Geerts A, Berre-voet F, Rogiers X, et al. Echocardiography for the detection of portopulmonary hypertension in liv-er transplant candidates: an analysis of cutoff values. Liver Transpl. 2013;19(6):602-10.

  18. Porres-Aguilar M, Gallegos-Orozco JF, Garcia H, Aguirre J, Macias-Rodriguez RU, Torre-Delgadillo A. Complicaciones vasculares pulmonares en hi-pertensión pulmonar y enfermedades hepáticas: una revisión concisa. Rev Gastroenterol Mex. 2013;78(1):35-44.

  19. Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in pa-tients with cirrhosis. J Hepatol. 2006;44(5):994-1002.

  20. Adinolfi LE, Restivo L, Zampino R, Guerrera B, Lonardo A, Ruggiero L, et al. Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis. Atherosclerosis. 2012; 221(2):496-502.

  21. Wang J, Wang Q, Yu G, She Q, Zhang W, Zhang J. Correlation Between Liver Stiffness Measured by Shear Wave Elastography and Child-Pugh Classi-fication. J Ultrasound Med. 2018;37(9):2191-9.

  22. Armstrong WF, Ryan T. Feigenbaum's Echocardi-ography. 8ª ed. Philadelphia: Wolters Kluwer; 2018. p. 363-462.

  23. García-Fernández MA, Zamorano J, Azevedo J. Doppler tissue imaging echocardiography. Ma-drid: McGraw-Hill Interamericana; 1998. pp. 23-45.

  24. Sonny A, Govindarajan SR, Jaber WA, Cywinski JB. Systolic heart failure after liver transplanta-tion: Incidence, predictors, and outcome. Clin Transplant [Internet]. 2018 [28 Abr 2019];32(3): e13199. Disponible en: https://doi.org/10.1111/ctr.13199

  25. Rahman S, Mallett SV. Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients. World J Hepatol. 2015;7(3):507-20.

  26. Licata A, Mazzola A, Ingrassia D, Calvaruso V, Cammà C, Craxì A. Clinical implications of the hyperdynamic syndrome in cirrhosis. Eur J In-tern Med. 2014;25(9):795-802.

  27. Josefsson A, Fu M, Björnsson E, Kalaitzakis E. Prevalence of pre-transplant electrocardiographic abnormalities and post-transplant cardiac events in patients with liver cirrhosis. BMC Gastroente-rol [Internet]. 2014 [29 Abr 2019];14:65. Disponi-ble en: https://doi.org/10.1186/1471-230X-14-65

  28. Wroński J, Fiedor P, Kwolczak M, Górnicka B. Re-trospective analysis of liver cirrhosis influence on heart walls thickness. Pathol Res Pract. 2015; 211(2):145-9.

  29. Pozzi M, Carugo S, Boari G, Pecci V, de Ceglia S, Maggiolini S, et al. Evidence of functional and structural cardiac abnormalities in cirrhotic pa-tients with and without ascites. Hepatology. 1997;26(5):1131-7.

  30. Fukazawa K, Gologorsky E, Manmohansingh V, Nishida S, Vigoda MM, Pretto EA Jr. Is the imme-diate reversal of diastolic dysfunction of cirrhotic cardiomyopathy after liver transplantation a sign of the metabolic etiology? Liver Transpl. 2009; 15(11):1417-9.

  31. Somani PO, Contractor Q, Chaurasia AS, Rathi PM. Diastolic dysfunction characterizes cirrhotic cardiomyopathy. Indian Heart J. 2014;66(6):649-55.

  32. Castellanos MI, Rogel BI, Rodríguez F, Arjona IA, Lazo del Vallin S. Disfunción cardiaca en la cirro-sis hepática. Rev Cuban Med [Internet]. 2014 [30 Abr 2019];53(2):189-200. Disponible en: http://scielo.sld.cu/pdf/med/v53n2/med08214.pdf

  33. Torregrosa M, Aguadé S, Dos L, Segura R, Gónza-lez A, Evangelista A, et al. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol. 2005;42(1):68-74.

  34. Lenci I, Alvior A, Manzia TM, Toti L, Neuberger J, Steeds R. Saline contrast echocardiography in pa-tients with hepatopulmonary syndrome awaiting liver transplantation. J Am Soc Echocardiogr. 2009;22(1):89-94.

  35. Dowsley TF, Bayne DB, Langnas AN, Dumitru I, Windle JR, Porter TR, et al. Diastolic dysfunction in patients with end-stage liver disease is associ-ated with development of heart failure early after liver transplantation. Transplantation. 2012;94(6): 646-51.

  36. Enache I, Oswald-Mammosser M, Woehl-Jaegle ML, Habersetzer F, Di Marco P, Charloux A, et al. Cirrhotic cardiomyopathy and hepatopulmonary syndrome: prevalence and prognosis in a series of patients. Respir Med. 2013;107(7):1030-6.

  37. Merli M, Calicchia A, Ruffa A, Pellicori P, Riggio O, Giusto M, et al. Cardiac dysfunction in cirrho-sis is not associated with the severity of liver dis-ease. Eur J Intern Med. 2013;24(2):172-6.

  38. Papastergiou V, Skorda L, Lisgos P, Papakonstan-tinou N, Giakoumakis T, Ntousikos K, et al. Ultra-sonographic prevalence and factors predicting left ventricular diastolic dysfunction in patients with liver cirrhosis: is there a correlation between the grade of diastolic dysfunction and the grade of liver disease? ScientificWorldJournal [Inter-net]. 2012 [citado 31 Abr 2019];2012:615057. Dispo-nible en: https://doi.org/10.1100/2012/615057

  39. Fajardo MH, Arce M, Medina Y, Esteva L, Osorio MF. Comportamiento de la cirrosis hepática en el hospital “Arnaldo Milián Castro” de julio de 2007 a marzo de 2009. Medisur [Internet]. 2010 [citado 31 Abr 2019];8(4):257-65. Disponible en: http://medisur.sld.cu/index.php/medisur/article/view/1154/7179

  40. Al-Hamoudi WK. Cardiovascular changes in cir-rhosis: pathogenesis and clinical implications. Saudi J Gastroenterol. 2010;16(3):145-53.

  41. Bernardi M, Calandra S, Colantoni A, Trevisani F, Raimondo ML, Sica G, et al. Q-T interval prolonga-tion in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology. 1998;27(1):28-34.

  42. Oberkofler CE, Dutkowski P, Stocker R, Schuep-bach RA, Stover JF, Clavien PA, et al. Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mor-tality in liver transplant recipients. Crit Care [In-ternet]. 2010 [citado 31 Abr 2019];14(3):R117. Dis-ponible en: http://doi.org/10.1186/cc9068

  43. Alexopoulou A, Papatheodoridis G, Pouriki S, Chrysohoou C, Raftopoulos L, Stefanadis C, et al. Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis. Transpl Int. 2012;25(11):1174-81.

  44. Krowka MJ, Swanson KL, Frantz RP, McGoon MD, Wiesner RH. Portopulmonary hypertension: Re-sults from a 10-year screening algorithm. Hepa-tology. 2006;44(6):1502-10.

  45. Krowka MJ, Miller DP, Barst RJ, Taichman D, Dweik RA, Badesch DB, et al. Portopulmonary hypertension: a report from the US-based RE-VEAL Registry. Chest. 2012;141(4):906-15.

  46. Fritz JS, Fallon MB, Kawut SM. Pulmonary vascu-lar complications of liver disease. Am J Respir Crit Care Med. 2013;187(2):133-43.

  47. Talwalkar JA, Swanson KL, Krowka MJ, Andrews JC, Kamath PS. Prevalence of spontaneous porto-systemic shunts in patients with portopulmonary hypertension and effect on treatment. Gastroen-terology. 2011;141(5):1673-9.

  48. Zambruni A, Di Micoli A, Lubisco A, Domenicali M, Trevisani F, Bernardi M. QT interval correc-tion in patients with cirrhosis. J Cardiovasc Elec-trophysiol. 2007;18(1):77-82.

  49. Huo TI, Lee SD, Lin HC. Selecting an optimal prognostic system for liver cirrhosis: the model for end-stage liver disease and beyond. Liver Int. 2008;28(5):606-13.

  50. Bernardi M, Calandra S, Colantoni A, Trevisani F, Raimondo ML, Sica G, et al. Q-T interval prolonga-tion in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology. 1998;27(1):28-34.

  51. Zamirian M, Tavassoli M, Aghasadeghi K. Cor-rected QT interval and QT dispersion in cirrhotic patients before and after liver transplantation. Arch Iran Med. 2012;15(6):375-7.

  52. Krowka MJ. Hepatopulmonary syndrome versus portopulmonary hypertension: distinctions and dilemmas. Hepatology. 1997;25(5):1282-4.

  53. Sagnelli E, Stroffolini T, Mele A, Almasio P, Cop-pola N, Ferrigno L, et al. The importance of HCV on the burden of chronic liver disease in Italy: a multicenter prevalence study of 9,997 cases. J Med Virol. 2005;75(4):522-7.

  54. Escobar Suárez BJ. Repercusión de la capacidad de respuesta cardiovascular en la estabilidad hemodinámica y la aparición de complicaciones en trasplante hepático [Tesis]. España: Universi-dad de Barcelona [Internet]; 2013. Disponible en: https://www.tdx.cat/handle/10803/121242

  55. Hoeper MM, Krowka MJ, Strassburg CP. Porto-pulmonary hypertension and hepatopulmonary syndrome. Lancet. 2004;363(9419):1461-8.

  56. Kamath PS. Portopulmonary hypertension and hepatopulmonary syndrome. J Gastroenterol Hepatol. 2002;17(Supl 3):S253-5.

  57. Wiegand J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Dtsch Arztebl Int. 2013;110(6):85-91.

  58. Pascasio JM, Grilo I, López-Pardo FJ, Ortega-Ruiz F, Tirado JL, Sousa JM, et al. Prevalence and se-verity of hepatopulmonary syndrome and its in-fluence on survival in cirrhotic patients evaluated for liver transplantation. Am J Transplant. 2014; 14(6):1391-9.

  59. Alonso Martínez JL, Zozaya Urmeneta JM, García Sanchotena JL, Olaz-Preciado F, Estébanez-Esté-banez C, Berjón-Reyero J. Síndrome hepatopul-monar: Relación con el grado de disfunción hepá-tica y el trastorno hemodinámico de la cirrosis hepática. Med Clin (Barc). 2004 Nov 27;123(19): 721-5.

  60. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB; ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmo-nary-Hepatic vascular Disorders (PHD). Eur Res-pir J. 2004;24(5):861-80.

  61. Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut. 2002;51(6):853-9.

  62. Zardi EM, Zardi DM, Chin D, Sonnino C, Dobrina A, Abbate A. Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase. J Cardiol. 2016;67(2):125-30.




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