Association of N- terminal pro brain natriuretic peptide with echocardiographic measures of diastolic dysfunction in cirrhosis

Background: Liver cirrhosis is associated with cardiac dysfunction in 40%-60% of the patients. Serum NT-ProBNP is a potential additional marker of cirrhotic cardiomyopathy. Materials and Methods: It was a cross-sectional analytical study done in a tertiary care center in South India on 100 patients of cirrhosis of liver. Diastolic function was assessed from mitral inflow parameters as well as tissue Doppler imaging of the left ventricle in 95 patients. Serum NT-ProBNP levels was measured once at the time of inclusion into the study. Cirrhotic cardiomyopathy was diagnosed in those with abnormal echocardiographic parameters and its association with NT-Pro BNP levels was analyzed. Data were analyzed using SPSS version 22. Results: Diastolic dysfunction was found in 40 (42.1%) participants. Twenty-two (23.2%) had Grade I, 16 (16.8%) had Grade II, and 2 (2.1%) had Grade III diastolic dysfunction. The mean NT-Pro-BNP was elevated (107.38 [+/- 66.76] ng/ml) in patients with diastolic dysfunction. NT-ProBNP was higher in Child-Pugh B and C disease when compared to milder disease. NT-ProBNP was not a good screening tool for cardiomyopathy in cirrhotic patients. Area under the curve was 0.517 with 95% confidence interval and the P = 0.77. However, positive correlation was present between the NT-ProBNP value and two echocardiographic parameters of diastolic dysfunction (E/A, E/E'). Conclusion: Increased serum NT-ProBNP levels in cirrhosis of liver have a positive correlation with echocardiographic measures of diastolic dysfunction of the heart but it is not a good tool for screening for cirrhotic cardiomyopathy.