Cardiac alterations in cirrhosis: reversibility after liver transplantation

• Published in: Journal of hepatology Vol. 42; no. 1; pp. 68 - 74
• Main Authors: Torregrosa, Mireia, Aguadé, Santi, Dos, Laura, Segura, Rosa, Gónzalez, Antonio, Evangelista, Artur, Castell, Joan, Margarit, Carlos, Esteban, Rafael, Guardia, Jaume, Genescà, Joan
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 2005; Elsevier
• Subjects: Abdomen; Adult; Aged; Ascites; Biological and medical sciences; Cardiac alterations; Complications of cirrhosis; Echocardiography; Female; Gastroenterology. Liver. Pancreas. Abdomen; Heart - physiopathology; Humans; Hypertrophy, Left Ventricular - etiology; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver Cirrhosis - physiopathology; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Myocardium - pathology; Nuclear cardiology; Other diseases. Semiology; Portal hypertension; Systole; Transplantation; Ventricular Function, Left; Nuclear cardiology; Transplantation; Complications of cirrhosis; Ascites; Cardiac alterations; Portal hypertension; Heart; Portal circulation disease; Effusion; Cardiovascular disease; Hepatic disease; Vascular disease; Cirrhosis; Treatment; Abdominal disease; Surgery; Digestive diseases; Graft; Complication; Reversibility
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2004.09.008

Liver cirrhosis induces cardiac alterations. We aimed to define these alterations and assess their reversibility after transplantation. Cirrhotic patients ( n=40) and controls ( n=15) underwent echocardiography and stress ventriculography. Fifteen cirrhotics were reevaluated 6–12 months after transplantation. Cirrhotics had higher left ventricular wall thickness (9.6±1.2 vs. 8.8±1.2 mm; P<0.05) and ejection fraction (73±6 vs. 65±4%, P<0.001) than controls. Basal diastolic function was similar. During stress, cirrhotics presented lower increases of heart rate, left ventricular ejection fraction, stroke volume and cardiac index ( P<0.05 for all), and diastolic dysfunction with lower ventricular peak filling rate ( P=0.001). Exercise capacity was reduced (48±21 vs. 76±24 W; P<0.001). Ascitic patients exhibited more diastolic dysfunction at rest and during stress compared to non-ascitic patients. Liver transplantation caused regression of ventricular wall thickness (10.2±1.3 vs. 9.5±1.2 mm; P<0.05), improvement of diastolic function, and normalization of systolic response and exercise capacity during stress (significant increases in heart rate, ventricular ejection fraction, stroke volume and cardiac index; P<0.05 for all). Cardiac alterations in cirrhosis present with mild increases in ventricular wall thickness, diastolic dysfunction that worsens with ascites and physical stress, and abnormal systolic response to stress limiting exercise capacity. Liver transplantation reverses these alterations.