Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Dimitroglou Ioannis
Dissertation committee:
Κωνσταντίνα Αγγέλη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσνταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Βλαχόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιγνάτιος Οικονομίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξοπούλου Αλεξάνδρα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κίμων Σταματελόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η χρήση των νεότερων υπερηχοκαρδιογραφικών τεχνικών και της μελέτης των μεγάλων αγγείων ως προγνωστικοί δείκτες σε ασθενείς με κίρρωση ήπατος
Translated title:
Utility of novel echocardiographic techniques and of the study of great vessels as a prognostic marker in patients with liver cirrhosis
Summary:
Introduction
Liver cirrhosis (LC) is characterized by vasodilation, reduced peripheral resistances, increased cardiac output and diastolic dysfunction. Novel echocardiography indices as well as arterial stiffness have shown increasing role for the diagnosis of various cardiovascular diseases. They also exhibit prognostic significance. However, their role in LC has not been studied extensively. The purpose of the study was the correlation of these parameters with the severity of the liver disease as well as with the patient prognosis.
Methods
A total of 104 adult cirrhotic patients in stable clinical condition were examined and among them 87 satisfied the inclusion criteria. Patients older than 75 years old with coronary artery disease, atrial fibrillation, moderate or severe cardiac valve disease, recent or ongoing alcohol consumption and hepatocellular carcinoma were excluded from the study. In addition, patient with poor acoustic window were also excluded. Α comprehensive echocardiography study was performed with off-line analysis of the stored images with a dedicated software. PWV was calculated by dividing the estimated distance difference between the femoral and carotid arteries by the pulse transit time measured with a validated noninvasive device (simultaneous measurement with two transducers). Sphygmocore device was used to measure the parameters related to the central aortic pressure waveform as derived from radial artery waveforms. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score and Child-Pugh Classes. Follow-up was 24 months and all-cause death was defined as the primary endpoint.
Results
Mean age was 57.9 (8.4) years and 64 (73.6%) of patients were males. Cirrhosis disease was attributed to alcohol in 34 (39.1%), hepatitis virus in 15 (17.2%) ιογενούς, NASH mediated in 20 (23.0%), autoimmune in 14 (16.1%), and in 4 (4.6%) underlying etiology was not identified. Among the patients, in 61 (70.1%) cirrhosis was decompensated and mean MELD score was 13.1 (6.7). According to the echocardiographic analysis mean left ventricular (LV) ejection fraction was 61(6)% and 15 (17.2%) patients had diastolic dysfunction. Mean values of the novel echocardiographic, as well as the arterial stiffnesss indices were not different between patients and controls. A correlation analysis found that global longitudinal strain (GLS), right ventricular free wall strain (RVFWS) and the ratio of the pulsed wave velocity (PWV) to the GLS (PWV/GLS) were significantly associated with the MELD score (p<0.001, p=0.002 and p=0.001 respectively). In addition LV elastance (Ees) and PWV were associated with Child-Pugh class. Among 87 patients a 24-month transplantation-free follow up was available in 77 among the latter group the primary endpoint was reached in 31 (40.3%). The variables of interest were not shown to be significantly associated with survival in the univariate Cox analysis. However, when age, sex, MELD, hemoglobin and platelet count were introduced in the analysis, GLS, left atrial strain (LASr), RVFWS, Ees, PWV and PWV/GLS were all significantly associated with the primary endpoint. In addition, HFA-PEFF score which combines echocardiographic variables with the natriuretic peptides was found increased in the patient groups and a high score was also associated with more advanced disease and worse prognosis in the univariate and multivariate Cox regression models.
Conclusions
In the current study GLS, RVFWS, Ees, PWV, PWV/GLS ratio and HFA-PEFF score were associated with the severity of cirrhosis. In addition, the same variables as well as LASr were all associated with worse survival in the multivariate analysis.
Main subject category:
Health Sciences
Keywords:
Liver cirrhosis, Cardiovascular system, Echocardiography, Cirrhotic cardiomyopathy, Speckle tracking echocardiography, Arterial stiffness
Number of references:
112
