Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with Child-Pugh A and B cirrhosis: A case-control study

Background Although studies have proven that liver cirrhosis affects cardiac hemodynamics by means of circulatory overload, they present with definite cardiac functional alteration mostly with end-stage disease. There is limited data on relationship between progression of cirrhosis, cardiac mechanics and sub-clinical dysfunction. This study was done to assess ventricular myocardial mechanics using speckle tracking and deformation imaging among Child-Turcotte-Pugh (CTP) classification A and B cirrhosis. Method Seventy patients with cirrhosis of Child-Pugh A/B class and sixty-two healthy subjects were prospectively evaluated by standard conventional echocardiography and deformation imaging with rotational echocardiography. Clinical stage of liver cirrhosis was assessed by model for end-stage liver disease (MELD) scores and CTP classification. Results Mean ages of patients with cirrhosis and controls were 55.64 +/- 14 years and 52.24 +/- 12 years, respectively. Though left ventricular (LV) dimensions (end diastolic dimension: 47.27 +/- 4.6 mm vs. 45.03 +/- 3.8 mm, p = 0.003; end systolic dimension: 30.33 +/- 4.9 mm vs. 28.40 +/- 2.91 mm, p = 0.006) and volumes (end diastolic volume: 82.08 +/- 22.53 mL vs. 68.18 +/- 15.75 mL, p = 0.001; end systolic volume: 28.60 +/- 8.42 mL vs. 22.18 +/- 7.48 mL, p = 0.001) were significantly higher in patients with cirrhosis, mean ejection fraction (EF) by Simpsons method was higher among controls (65.83 +/- 5.79% vs. 68.35 +/- 5.79%, p = 0.009). Left atrial volume was higher in cirrhosis group indicating presence of diastolic dysfunction (41.24 +/- 14.10 mL vs. 26.08V6.4 mL, p = 0.001). Global longitudinal strain as assessed by speckle tracking echocardiography did not show statistical significant difference between two groups (-22.35 +/- 4.08% vs. -21.80 +/-;2.54%, p = 0.348). Median value of torsion parameters in patients with cirrhosis did not differ compared to controls (torsion in degrees: 2.46 vs. 2.79, p = 0.268). Conclusion Patients with Child-Pugh A and B stages of cirrhosis present with preserved longitudinal strain, normal torsion but with subtle diastolic dysfunction. Higher MELD score may correlate with increased longitudinal strain possibly due to hyperdynamic state.