Abstract 542: Diastolic Dysfunction in Cirrhosis: Does it Really Exist?
Background: Although abnormal diastolic performance in the presence of hyperdynamic systolic function is said to be prevalent in patients with cirrhosis (so called cirrhotic cardiomyopathy), few data exist to support this contention. The aim of this study was to define the status of diastolic filling dynamics in patients with end stage liver disease (ESLD).
Methods: We performed restrospective review of 500 consecutive patients with ESLD and LVEF>50% on the UCSD liver transplant list. From these, 149 patients were included in the study after excluding those with any condition previously associated with diastolic dysfunction (DD) including hypertension, diabetes, CAD and myocardial infiltration. These patients were compared with 73 age and gender matched controls. All patients had transthoracic echocardiography in the standard manner along with an EKG. Cirrhosis was due to hepatitis in 75 patients (50%), alcohol in 34 (23%), both in 11 (7%), cryptogenic in 13 (9%) and other causes (drugs, NASH, primary biliary cirrhosis and sclerosing cholangitis) in 16 (11%).
Results: The mean age of ESLD patients was 51±9years and 68% were male. Compared to controls, patients with ESLD had a higher EF (67 ± 7 vs. 64 ± 6%; p = 0.001), CO (6.7 ± 2.7 vs. 5.1 ± 1.4 L/min; p = 0.001) and increased left ventricular end diastolic diameter (LVIDd) and left atrial diameter (LAD) (5.1 ± 0.7 vs 4.8 ± 0.6 and 4.4 ± 0.6 vs. 3.8 ± 0.6cm respectively; p = 0.005 and < 0.001). Patients with ESLD had a higher mitral E velocity (92.3 ± 22 vs. 82.4 ± 21 cm/sec; p = 0.004) and higher ratio of E/E′ in septal and lateral walls compared to control patients (10 ± 2.6 and 7.6 ± 2.6 vs. 8.3 ± 2.5 and 6.6 ± 2 respectively; p<0.001 and 0.008). Mitral A velocity and E/A ratio, mitral deceleration time and pulmonary vein “A” duration and systolic filling fraction were similar in ESLD and controls. Longer QTc was observed in the cirrhotic patients (456±25 vs. 427±31; p<0.001).
Conclusions: Patients with ESLD have a hyperdynamic circulation manifested by increased EF and CO, as well as increased LVIDd, LAD, E and E/E′ ratio. However the parameters of diastolic dynamics still fall within currently accepted normal limits. Thus, in a selected population with ESLD and no other comorbid conditions, DD does not appear to be clinically significant.