Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging

Background: Cirrhotic cardiomyopathy is described as latent cardiac failure. However, it remains to be investigated whether the myocardial dysfunction is present even at rest. Aims: The aim of the present study was to quantify left ventricular function at rest by means of tissue Doppler imaging in patients with cirrhosis and relate the findings to liver status and cirrhosis aetiology. Methods: Forty- four consecutive patients and 23 age-matched healthy controls were included. Conventional echocardiographic- and tissue Doppler-derived indices of systolic and diastolic function were obtained. Liver function was quantified by the galactose elimination capacity and clinical stage by the Child-Pugh and MELD scores. Results: Both systolic and diastolic myocardial functions were compromised in the patients at rest. Left ventricular ejection fraction (56.4 +/- 6.1 vs. 59.9 +/- 3.9%, P < 0.02), mean peak systolic tissue velocity (4.6 +/- 0.9 vs. 5.6 +/- 0.7 cm/s, P < 0.001) and mean systolic strain rate (-1.23 +/- 0.19 vs. -1.5 +/- 0.14/s, P < 0.001) were all reduced in cirrhosis patients. Thirty-four patients (54%) had diastolic dysfunction, 11 had impaired diastolic relaxation pattern (25%), 12 had the more severe pseudo-normal filling pattern (27%) and one had restrictive filling or severe diastolic dysfunction (2%). None of the echocardiographic findings were related to the cirrhosis aetiology. Conclusion: Tissue Doppler imaging during rest detected substantial systolic and diastolic myocardial dysfunction in cirrhotic patients. This supports the existence of a distinct cirrhotic cardiomyopathy.