Prevalence,clinical Features And Risk Factors Of Cirrhotic Cardiomyopathy Assessed By Two-dimensional Speckle Tracking Imaging

Background:Cirrhotic cardiomyopathy(CCM)is a cardiac complication secondary to liver cirrhosis.It increases the risk of gastrointestinal bleeding and renal insufficiency and increases the incidence of adverse cardiovascular events after liver transplantation.However,most clinical studies on this specific population are focused on liver transplant candidates,and the main etiology of cirrhotic patients included in relevant foreign studies is alcoholic cirrhosis,so study results can not be applied to all cirrhotic patients.Because cardiac dysfunction is insidious in patients with CCM in the calm state,it can be easily missed or delayed.The Cirrhotic Cardiomyopathy Association updated the diagnostic criteria of CCM in 2020,to perform a more comprehensive assessment of cardiac function using newer echocardiographic techniques.At present,the real prevalence of CCM still needs to be reassessed.In addition,studies on the analysis of risk factors of CCM are still insufficient.This study aims to evaluate the changes of cardiac structure and function in patients with liver cirrhosis,determine the prevalence of CCM,and further analyze its clinical related risk factors.Methods:Patients with cirrhosis aged 18 to 75 years were prospectively recruited as an experimental group from Qilu Hospital of Shandong University between November 2020 and November 2021.Matched subjects without cardiovascular disease admitted for gastrointestinal polyps and functional gastrointestinal disorders were recruited as controls in the same period.The demographic data and laboratory indices such as liver function,renal function,serum electrolytes,routine blood,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were collected.12 lead ECG and echocardiogram were performed.To analyze the cardiac involvement of patients with cirrhosis based on laboratory indices and ultrasound parameters.To evaluate the severity of liver cirrhosis according to the modified Child-Pugh score and albumin-bilirubin score(ALBI),and to analyze the correlation between cardiac dysfunction and the severity of cirrhosis.In addition,to assess the prevalence of CCM and to further explore the associated risk factors of CCM.Results:A total of 108 patients with cirrhosis and 53 matched subjects were finally included.Compared to controls,patients with cirrhosis had significantly higher NT-proBNP serum levels[65.07(31.43～129.38)vs 44.92(22.10-65.58),P=0.001]and lower mean arterial pressure(82±10 vs 93±9,P<0.001).Patients with cirrhosis had impaired left heart diastolic and systolic function,increased left atrial dimensions[39.00(37.00～41.00)vs 34.00(31.00～36.00),P<0.001]and increased left ventricular end diastolic diameter[47.00(45.00～49.00)vs 46.00(44.00～48.00),P=0.026],increased peak tricuspid regurgitation velocity[2.45(2.34～2.56)vs 2.39(2.27～2.50),P=0.020],increased absolute myocardial global longitudinal strain(GLS)[20.50(19.13～22.20)vs 19.00(17.15～20.30),P<0.001],and increased pulmonary artery systolic pressure(PASP)[29.00(27.00～31.00)vs 28.00(25.50～30.00),P=0.011].The overall prevalence of CCM among patients with liver cirrhosis was 24.1%.With the aggravation of liver cirrhosis,the prevalence of CCM increased.The risk of CCM in patients with child-B/C cirrhosis was significantly higher than that in patients with child-A cirrhosis(35.7%vs 16.7%,P=0.024).The prevalence of CCM was significantly higher in cirrhosis patients combined with ascites(33.3%vs 14.8%,P=0.024)or combined with portal vein thrombosis(PVT)(45.2%vs 15.6%,P=0.001).Older age,ascites,PVT,lower hemoglobin level,and higher NT-proBNP were the risk factors for CCM.Older age[OR=1.077,95%CI(1.011～1.148),P=0.021]and PVT[OR=4.003,95%CI(1.391～11.519),P=0.010]were independent risk factors for the development of CCM.Conclusion:Patients with advanced cirrhosis have decreased mean arterial pressure and increased serum NT-proBNP levels.The prevalence of CCM in patients with cirrhosis is 24.1%.CCM is independent of the etiology of liver cirrhosis.The prevalence of CCM tends to increase with increasing severity of cirrhosis.The prevalence of CCM is higher in patients with cirrhosis combined with ascites or PVT.Older age and PVT are independent risk factors for the development of CCM in cirrhotic patients,but validation in larger sample studies is still needed.