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Disturbed cardiac hemodynamics in patients with viral cirrhosis of the liver

Chistyakova M.V., Govorin A.V., Starnovskaya E.N., Radaeva E.V.

Keywords: cardiodynamics, function impairment, cirrhosis

DOI: 10.18087 / rhfj.2014.3.1937

Background. In the recent decades, incidence of viral cirrhoses of liver (VCL) has been reported to increase with progression and development of cirrhotic cardiomyopathy. Aim. To study the effect of VCL on indices of global and segmental systolic and diastolic ventricular function, LV myocardial deformation, and splanchnic circulation. Materials and methods. 75 patients with Child-Pugh class A, B and C VCL were evaluated. Patients were divided into two groups, with and without ascites. Doppler EchoCG, tissue Doppler EchoCG, blood vessel duplex scanning, and two-dimensional tracking of grayscale spots were performed. Results. Patients with VCL had impaired LV global systolic function; increased Tei index at the level of tricuspid annulus; reduced rapid filling flow at the lateral wall medial segment of both ventricles; reduced rapid filling flow and Еm / Аm ratio at the posterior septum; prolonged isovolumic relaxation time at the LV lateral wall; increased LV myocardial mass; and dilatation of the left atrium, pulmonary artery and splanchnic arteries and veins. These changes were more pronounced in patients with ascites (р <0.001). Global and segmental (frontoseptal, inferiolateral, inferior, an inferioseptal) systolic strain was reduced and heart rate, LV cardiac output and cardiac index were increased (р <0.001). The disorder in LV and RV diastolic function provided a decreased in peak systolic strain (р <0.001). Relationships between the peak global deformation and hepatoportal hemodynamic parameters and heart structure and function parameters were studied in all VCL patients. Conclusion. Patients with VCP without ascites had reduced LV segmental diastolic function, a segmental decrease in RV rapid filling flow and increases in LV myocardial mass, left atrial cavity, pulmonary artery, and splanchnic arteries and veins. These changes were more pronounced in patients with ascites. The presence of ascites was associated with increased pulmonary artery pressure, decreased global and segmental longitudinal systolic strain, and increased heart rate, which resulted in increased cardiac output and cardiac index. Ventricular diastolic dysfunction provided a decrease in segmental systolic strain.
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Chistyakova M.V., Govorin A.V., Starnovskaya E.N. et al. Disturbed cardiac hemodynamics in patients with viral cirrhosis of the liver. Russian Heart Failure Journal. 2014;84 (3):179–184

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