A study of cardiac dysfunction in cirrhotics

Background: The heart and liver are organs that are closely related in both health and disease. Due to the limited number of human studies, the management of cirrhotic cardiomyopathy remains largely empirical. Material and methods: 30 Patients included in the study were recruited from the Department of Medical Gastroenterology, Narayana Medical College Hospital, Nellore. Consecutive patients diagnosed to have cirrhosis of nonalcoholic etiology formed the study group. The parameters that were assessed in echocardiography are E/A ratio, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction. QTc interval more than 440 msec and E/A ratio less than 1 were considered diagnostic of cirrhotic cardiomyopathy in this study. Results: In 9 cases, cirrhosis was due to hepatic B viral infection, 4 due to hepatitis C and in 17 patients it was cryptogenic. Of the 30 cases included in the study, 7 cases (23.3%) had Class A CTP. 16 cases (53.3%) had Class B CTP, 7 cases had Class C CTP. Of the 30 patients included in this study, 21 patients had end diastolic volume above 90. 2 patients had end systolic volume above 38. 29 patients had ejection fraction above 60%. Out of the 30 cases, 23 showed features of cirrhotic cardiomyopathy. 7 patients had CTP Class A. 16 patients had CTP Class B.7 patients had CTP Class C. 12 patients with cirrhotic cardiomyopathy had CTP Class B. 7 patients with cirrhotic cardiomyopathy had CTP Class C. 3 patients with CTP Class A and 4 patients with CTP Class B did not have cirrhotic cardiomyopathy. The QTc was prolonged in 16 (53.3%) of patients in this study. 29 cases had ejection fraction above 60. Of the 23 cases that had cirrhotic cardiomyopathy 21 cases had ascites. 27 of the 30 cases had varices. 70.0% of the cases had end diastolic volume above 90. 76.2% of the cases with EDV above 90 had E/A ratio below 1. Conclusion: Cirrhotic patients with non alcoholic etiology do have evidence of cirrhotic cardiomyopathy. The presence of cirrhotic cardiomyopathy was independent of the etiology. Some degree of diastolic dysfunction is seen in most of the cirrhotics. Prolongation of QTc interval correlates with severity of cirrhosis. Ventricular end diastolic volume, end systolic volume and ejection fraction do not correlate with severity of cirrhosis.