Cardiac dysfunction in patients of cirrhosis of the liver and its correlation with Child-Pugh score: A cross-sectional study at a tertiary care center in Northern India.

Abstract

Introduction: Chronic liver disease is the destruction and regeneration process of the liver parenchyma. Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation, cirrhotic cardiomyopathy (CCM), and pulmonary vascular abnormalities. CCM was first defined in 2005 at the Montreal World Congress of Gastroenterology. It is considered a condition of latent heart failure that manifests only under stress, resulting in a blunted increase in cardiac output during exercise.

Methods: A total of 100 cases as per the diagnostic criteria of liver cirrhosis were enrolled from the Department of General Medicine of PGIMS, Rohtak. The assessment of cardiac function was done in all the patients. Two-dimensional echocardiogram was done to find evidence of cardiomyopathy and electrocardiogram (ECG) was done to find QT-interval prolongation. Child Turcotte Pugh (CTP) score was calculated for severity. The cardiac dysfunction was compared to the seriousness of the CTP score.

Results: In our study, 57% of patients showed diastolic dysfunction while systolic dysfunction was not seen in any case. Furthermore, 56% of the cases had prolonged QTc interval in ECG. Our study also shows that there is a definitive association between QTc prolongation and disease severity.

Conclusion: CCM is considered an important predictor of morbidity and mortality. The left ventricular ejection fraction at rest is normal in CCM, but there is a blunted increase in cardiac index and cardiac output during exercise. This is difficult to identify because these symptoms are similar to fatigue and exercise intolerance commonly seen in cirrhotic patients.