2017


To access this material please log in or register

Register Authorize
2017/№2

Some features of pulmonary circulation and hepatolienal blood flow remodeling in patients with viral cirrhosis

Chistyakova M. V., Govorin A. V., Radaeva E. V.
Federal State Budgetary Educational Institution of Higher Professional Education "Chita State Medical Academy" of the Ministry of Health of the Russian Federation, Gorkogo 39a, Chita 672090, Transbaikalia Region

Keywords: cirrhosis, right ventricle

DOI: 10.18087/rhfj.2017.2.2320

Background. Possible emergence of specific myocardial disorders associated with viral cirrhosis (VC) has been relatively recently recognized. Features of pulmonary circulatory disorders and relationship of these disorders with peculiarities of portal blood flow in VS are understudied. Aim. To study effects of VC on some parameters of pulmonary circulation and indexes of hepatolienal blood flow. Materials and methods. 95 patients (mean age, 41.2) with VC were evaluated. 58 patients did not have ascites (group 1); 37 patients had ascites of different severity (group 2); the control group consisted of 22 healthy individuals. Doppler EchoCG, tissue Doppler EchoCG, and Doppler ultrasound of hepatic arteries were performed using a VIVID‑S5 (USA) instrument. Results. Patients with VC had right ventricular (RV) hypertrophy and disturbed RV diastolic function; more pronounced changes were observed in patients with ascites (р<0.001). The presence of ascites was associated with increased Tei index, velocity of pulmonary artery (PA) blood flow, and an increase in PA systolic blood pressure to 36 [26; 39] mm Hg vs. 28 [19; 32] mm Hg in group 1 and 24 [11; 26] mm Hg in the control group (р<0.001). Maximum systolic velocity of tricuspid annular motions was decreased in 21 (36%) patients with ascites and in 6 (16%) patients without ascites. All VC patients had increased diameters of arteries (hepatic, splenic) and veins (splenic, portal) compared to the control; the largest vascular diameter was observed in patients with ascites (р<0.001). In addition, indexes characterizing disorders of splanchnic circulation (dilation of portal and splenic veins) correlated with parameters of cardiac hemodynamics, PA diameter (r=0.60; p<0.001), LV EF (r=0.75; р<0.001), and presence of moderate pulmonary hypertension (PH) (r=0.91; р<0.001). Correlations were found between PA pressure and the Tei index (r=0,74; р<0,001), and the Е/А ratio for diastolic tricuspid annular motions (r=0.54; p<0.001). Conclusion. VC patients with ascites had more severe RV myocardial dysfunction than patients without ascites as indicated by more pronounced disorders of myocardial structure indexes, impaired RV diastolic filling, increased PA pressure and deformation of hepatolienal blood flow. These results indicated a close relationship of cardiac hemodynamic disorders with hepatic portal circulation.
  1. Конышева А. А., Моисеев С. В., Сагинова Е. А., Краснова Т. Н., Абдурахманов Д. Т. Цирротическая кардиомиопатия. Клиническая фармакология и терапия. 2012;21(4):63–8 [Kony`sheva A. A., Moiseev S. V., Saginova E. A., Krasnova T. N., Abduraxmanov D. T. Czirroticheskaya kardiomiopatiya. Klinicheskaya farmakologiya i terapiya. 2012;21(4):63–8].
  2. Teuber G, Teupe C, Dietrich CF, Caspary WF, Buhl R , Zeuzem S. Pulmonary dysfunction in noncirrhotic patients with chronic viral hepatitis. Eur J Intern Med. 2002;13(5):311–8.
  3. Лопаткина Т. Н., Стрижаков Л. А., Конышева А. А., Танащук Е. Л., Таранова М. В., Моисеев С. В. Варианты поражения сердца при хроническом гепатите C. Клиническая фармакология и терапия. 2014;23(4):90–4 [Lopatkina T. N., Strizhakov L. A., Kony`sheva A. A., Tanashhuk E. L., Taranova M. V., Moiseev S. V. Varianty` porazheniya serdcza pri xronicheskom gepatite C. Klinicheskaya farmakologiya i terapiya. 2014;23(4):90–4].
  4. Гарбузенко Д. В. Портопульмональная гипертензия и гепатопульмональный синдром у больных циррозом печени. Пульмонология. 2006;(1):103–7 [Garbuzenko D. V. Portopul`monal`naya gipertenziya i gepatopul`monal`ny`j sindrom u bol`ny`x czirrozom pecheni. Pul`monologiya. 2006;(1):103–7].
  5. Крель П. Е., Цинзерлинг О. Д. Внепеченочная локализация вируса гепатита С: особенности клинических проявлений и прогностическая значимость. Терапевтический архив. 2009;81(11):63–8 [Krel` P. E., Czinzerling O. D. Vnepechenochnaya lokalizacziya virusa gepatita C: osobennosti klinicheskix proyavlenij i prognosticheskaya znachimost`. Terapevticheskij arxiv. 2009;81(11):63–8].
  6. Калачева Т. П., Чернявская Г. М., Белобородова Э. И. Влияние легочной гипертензии на течение цирроза печени и факторы, определяющие прогноз заболевания. Сердце: журнал для практикующих врачей. 2013;12(6):391–6. DOI:10.18087/rhj.2013.6.1805 [Kalacheva T. P., Chernyavskaya G. M., Beloborodova E`. I. Vliyanie legochnoj gipertenzii na techenie czirroza pecheni i faktory`, opredelyayushhie prognoz zabolevaniya. Serdcze: zhurnal dlya praktikuyushhix vrachej. 2013;12(6):391–6. DOI:10.18087/rhj.2013.6.1805].
  7. Ивашкин В. Т., Морозова М. А., Маевская М. В. Гепатопульмональный синдром: диагностика, патогенез, клиническая симптоматика и способы лечения. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2008;18(2):12–7 [Ivashkin V. T., Morozova M. A., Maevskaya M. V. Gepatopul`monal`ny`j sindrom: diagnostika, patogenez, klinicheskaya simptomatika i sposoby` lecheniya. Rossijskij zhurnal gastroe`nterologii, gepatologii, koloproktologii. 2008;18(2):12–7].
  8. Говорин А. В. Некоронарогенные поражения миокарда. –Новосибирск: Наука; 2014. 448 с [Govorin A. V. Nekoronarogenny`e porazheniya miokarda. –Novosibirsk: Nauka; 2014. 448 s].
  9. Соколова Н. А., Чарторижская Н. Н., Говорин А. В., Витковский Ю. А. Клининические и патоморфологические особенности поражения сердца у больных с острым отравлением уксусной кислотой. Сердце: журнал для практикующих врачей. 2011;10(4):245–6 [Sokolova N. A., Chartorizhskaya N. N., Govorin A. V., Vitkovskij Yu. A. Klininicheskie i patomorfologicheskie osobennosti porazheniya serdcza u bol`ny`x s ostry`m otravleniem uksusnoj kislotoj. Serdcze: zhurnal dlya praktikuyushhix vrachej. 2011;10(4):245–6].
  10. Мясоедова Е. И., Полунина О. С., Воронина Л. П., Севостьянова И. В., Гусейнов Г. Т. Особенности структурно‑геометрической перестройки левого желудочка у пациентов с ишемической кардиомиопатией. Забайкальский медицинский вестник. 2015;(4):12–5 [Myasoedova E. I., Polunina O. S., Voronina L. P., Sevost`yanova I. V., Gusejnov G. T. Osobennosti strukturno‑geometricheskoj perestrojki levogo zheludochka u paczientov s ishemicheskoj kardiomiopatiej. Zabajkal`skij mediczinskij vestnik. 2015;(4):12–5].
  11. Notomi Y, Srinath G, Shiota T, Martin‑Miklovic MG, Beachler L, Howell K et al. aturational and adaptive modulation of left ventricular torsional biomechanics: Doppler tissue imaging observation from infancy to adulthood. Circulation. 2006;113(21):2534–41. DOI:10.1161/CIRCULATIONAHA.105.537639.
  12. Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 2010;23(4):351‑369; quiz 453‑455. DOI:10.1016/j.echo.2010.02.015.
Chistyakova M. V., Govorin A. V., Radaeva E. V. Some features of pulmonary circulation and hepatolienal blood flow remodeling in patients with viral cirrhosis. Russian Heart Failure Journal. 2017;18 (2):102–106

To access this material please log in or register

Register Authorize
Ru En