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Left Ventricular Myocardial Mechanics in Cirrhosis: A Speckle Tracking Echocardiographic Study
Author(s) -
Pagourelias Efstathios D.,
Sotiriou Panagiota,
Papadopoulos Christodoulos E.,
Cholongitas Evaggelos,
Giouleme Olga,
Vassilikos Vassilios
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13010
Subject(s) - ejection fraction , medicine , cardiology , cirrhosis , speckle tracking echocardiography , diastole , basal (medicine) , pathophysiology , systole , heart failure , blood pressure , insulin
Cirrhosis is commonly associated with impaired left ventricular ( LV ) myocardial contractile reserve to stress and diastolic dysfunction. The aim of this study was to assess LV systolic performance at rest, using both “standard” echocardiographic indices and novel deformation–rotational parameters, in order to elucidate the pathophysiologic basis of cardiac dysfunction in cirrhosis. Seventy‐seven men with cirrhosis (mean age 54.4 ± 9.7) of variable C hild– P ugh class (A, B, C) and 20 healthy control subjects were prospectively evaluated by standard as well as speckle tracking echocardiography. Left ventricular ejection fraction ( LVEF ) was significantly higher in patients with cirrhosis compared to controls (64.6 ± 5.7% in controls vs. 71 ± 9.5%, 71.2 ± 7.1%, and 73 ± 7% in C hild– P ugh classes A, B, and C, respectively, P = 0.002). Interestingly, LV systolic function augmentation was not associated with changes in LV longitudinal deformation ( LV strain −19 ± 1.9% in controls vs. −20.1 ± 5.3% in class A vs. −21.3 ± 2.6% in class B vs. −21 ± 3.4% in class C, P = NS ), but a statistically significant increase in LV apical systolic rotation and accordingly in LV twist was observed ( LV twist 13.0 ± 3° in controls vs. 14.9 ± 5° in class A vs. 16.5 ± 2.8° in class B vs. 18.2 ± 2.9° in class C, P < 0.0005). Despite the increase in LV rotation, time to both basal and apical peak systolic rotation was significantly delayed in patients compared to healthy controls (P = 0.015 and P = 0.017 accordingly). Increased EF in cirrhosis could be attributed to increased LV torsion. Despite the “improved” rotation values at rest, there is a significant time delay in succeeding peak systolic rotation, hampering also the consequent untwisting–diastolic period.