Factors predicting Cardiac dysfunction in patients with cirrhosis of liver

Abstract

 Background and Aim: Left ventricular diastolic dysfunction (LVDD) is found to be earliest cardiac dysfunction noted in patients with cirrhosis of Liver, increasing morbidity and mortality in these patients. There are sparse studies from India evaluating the predictive factors of LVDD in cirrhotic patients, hence we undertook this prospective study with an aim to evaluate the factors predicting the development of LVDD in cirrhosis of liver.

Methods: A hundred four cirrhotic patients were enrolled in this prospective study. A detailed cardiac evaluation done by 2 D echocardiography with tissue doppler imaging by an experienced senior cardiologist. Severity of liver disease was defined by MELD and Child Pugh score.

Results: The prevalence of LVDD was 46% in our study. Multivariate logistic regression analysis revealed that serum albumin, MELD score and presence of ascites(OR=0.1,95%CI 0.03-0.3,p<0.001;Or=1.12,95%CI 1.03-1.22,p<0.001;OR=4.19,95%CI 1.38-12.65,p<0.01 respectively )were found to be independent predictors of LVDD in cirrhotic patients. Diastolic dysfunction was unrelated to age, gender and etiology of cirrhosis.The cirrhotic patients with LVDD had significantly higher child Pugh score, MELD score and lower serum albumin as compared to patients without LVDD. The echocardiographic parameters like E/e’ ratio, DT and LAVI were significantly different in cirrhotic patients with higher MELD and child Pugh score than lower.

Conclusion: The present study showed a significant correlation of diastolic dysfunction with severity of liver disease. Low serum albumin, high MELD score and presence of ascites significantly predicts development of LVDD in cirrhotic patients.