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Cardiac complications may predict mortality from cirrhosis

Cardiovascular complications — including increased left atrial dimension and heart rate and reduced mean arterial pressure — may predict an increased risk for mortality among patients with cirrhosis, according to a recently published study.

“We performed a prospective study assessing the cardiac dimensions, systolic and diastolic function, and hemodynamic parameters in a large cohort of patients with different stages of cirrhosis using a noninvasive state-of-the-art echocardiography technique, with the aim of investigating the predictive values of these parameters in the clinical course of these patients,” Maurizio Cesari, MD, PhD, from the University of Padova, Italy, and colleagues wrote.

From 2009 to 2012, the researchers followed 115 patients with cirrhosis and without history of arterial hypertension, cardiovascular disease, diabetes or heart valve disease for a median of 5 years. The patients underwent a hemodynamic evaluation and standard trans-thoracic Doppler echocardiography.

During follow-up, 54 patients died. Main causes of death included gastrointestinal hemorrhages, hepatorenal syndrome, liver failure, sepsis and hepatocellular carcinoma. Compared with surviving patients, those who died had higher MELD scores (16 vs. 11; P = .0001), Child-Pugh scores (9 vs. 7; P = .0001), average heart rates (77 vs. 70 bpm; P = .002), increased ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity or E/e’ (11.3 vs. 9.8; P = .03) and cardiac index (3.06 vs. 2.73; P = .008). They also had lower stroke work (13 vs. 14; P = .04) and systemic vascular resistance index (2,481 vs. 2,946; P = .0009).

After a multivariate analysis, the researchers observed that MELD score (HR = 1.15; 95% CI, 1.08-1.23), age (HR = 1.06; 95% CI, 1.02-1.1) and body surface area (HR = 0.09; 95% CI, 0.01-0.81) predicted mortality. Analysis incorporating only cardiovascular parameters showed that increased E/e’ (HR = 1.22; 95% CI, 1.07-1.38), heart rate (HR = 1.04; 95% CI, 1-1.08) and reduced mean arterial pressure (HR = 0.96; 95% CI, 0.93-0.99) significantly correlated with mortality rates.

“In line with other studies, we observed a predictive value of increased [left atrial] dimension, increased E/e’ and low [mean arterial pressure] whereas no effect of [left ventricular] mass was evident,” the researchers wrote. “Since increased [left atrial] dimension and E/e’ are strongly associated with increased [left ventricular] filling pressure we suggest that in cirrhotic patients with normal systolic function the reduction of [mean arterial pressure] and the increase in [left ventricular] filling pressure are the main cardiovascular predictors of death.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.