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- Title
Left Ventricular Myocardial Mechanics in Cirrhosis: A Speckle Tracking Echocardiographic Study.
- Authors
Pagourelias, Efstathios D.; Sotiriou, Panagiota; Papadopoulos, Christodoulos E.; Cholongitas, Evaggelos; Giouleme, Olga; Vassilikos, Vassilios
- Abstract
Cirrhosis is commonly associated with impaired left ventricular ( LV) myocardial contractile reserve to stress and diastolic dysfunction. The aim of this study was to assess LV systolic performance at rest, using both 'standard' echocardiographic indices and novel deformation-rotational parameters, in order to elucidate the pathophysiologic basis of cardiac dysfunction in cirrhosis. Seventy-seven men with cirrhosis (mean age 54.4 ± 9.7) of variable Child- Pugh class (A, B, C) and 20 healthy control subjects were prospectively evaluated by standard as well as speckle tracking echocardiography. Left ventricular ejection fraction ( LVEF) was significantly higher in patients with cirrhosis compared to controls (64.6 ± 5.7% in controls vs. 71 ± 9.5%, 71.2 ± 7.1%, and 73 ± 7% in Child- Pugh classes A, B, and C, respectively, P = 0.002). Interestingly, LV systolic function augmentation was not associated with changes in LV longitudinal deformation ( LV strain −19 ± 1.9% in controls vs. −20.1 ± 5.3% in class A vs. −21.3 ± 2.6% in class B vs. −21 ± 3.4% in class C, P = NS), but a statistically significant increase in LV apical systolic rotation and accordingly in LV twist was observed ( LV twist 13.0 ± 3° in controls vs. 14.9 ± 5° in class A vs. 16.5 ± 2.8° in class B vs. 18.2 ± 2.9° in class C, P < 0.0005). Despite the increase in LV rotation, time to both basal and apical peak systolic rotation was significantly delayed in patients compared to healthy controls (P = 0.015 and P = 0.017 accordingly). Increased EF in cirrhosis could be attributed to increased LV torsion. Despite the 'improved' rotation values at rest, there is a significant time delay in succeeding peak systolic rotation, hampering also the consequent untwisting-diastolic period.
- Subjects
LEFT heart ventricle; HEART physiology; CHI-squared test; CONFIDENCE intervals; STATISTICAL correlation; DOPPLER echocardiography; FISHER exact test; CIRRHOSIS of the liver; CARDIOMYOPATHIES; REGRESSION analysis; RESEARCH evaluation; STATISTICS; T-test (Statistics); DATA analysis; INTER-observer reliability; DATA analysis software; DESCRIPTIVE statistics; ONE-way analysis of variance; DISEASE complications
- Publication
Echocardiography, 2016, Vol 33, Issue 2, p223
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13010