Cirrhotic cardiomyopathy: Indian scenario

Background: Cirrhotic cardiomyopathy has been reported to be a major cause of morbidity and mortality in liver transplant recipients. However, there is scant data from Asia. With liver transplantation programs gradually being established in the region, Asian hepatologists are bound to face this entity. Methods: Thirty patients with alcoholic cirrhosis and 30 with cirrhosis of nonalcoholic etiology were enrolled, after excluding those with recent bleeding, gross ascites, severe anemia and other conditions which could alter cardiovascular status. Thirty healthy subjects without cardiovascular risk factors were enrolled as controls. Hepatic function status was assessed by biochemical tests and prothrombin time. Cardiac structural and functional assessment was performed non-invasively using transthoracic echocardiography. Results: Deceleration time was significantly (P < 0.05) prolonged in both the cirrhotic groups (235.03 +/- 44.23 ms and 255.87 +/- 46.16 ms) compared to controls (185.83 +/- 25.04 ms), indicative of diastolic dysfunction in cirrhotic patients. Other parameters, viz. ejection fraction, E : A ratio, left ventricular relative wall thickness, interventricular septal thickness and left ventricular systolic as well as diastolic chamber dimensions did not show statistically significant difference between any of the groups. Cardiac structural and functional parameters were not correlated with the severity of liver dysfunction. There was no statistically significant difference between the alcoholic and nonalcoholic groups. Conclusions: Asian patients with cirrhosis do have evidence of diastolic dysfunction. Cardiac structural and functional parameters did not correlate with the severity of liver dysfunction. Cardiac dysfunction seemed to be the consequence of cirrhosis itself, rather than of alcohol.