Relationship Between Echocardiographic Indexes And The Prognosis And TCM Syndrome Types Of Liver Cirrhosi

Purpose:Cardiac morphology and function,which are conventionally evaluated by echocardiography,are often abnormal in decompensated cirrhosis.We aimed to evaluate the association of echocardiography-related parameters with prognosis and traditional Chinese medicine syndromes in cirrhosis.Method:1.In this retrospective study,106 patients with cirrhosis were included,in whom cardiac structure and function,including mitral inflow early diastolic velocity/mitral inflow late diastolic velocity(E/A),left atrium diameter(LAD),left ventricular end-diastolic dimension(LVDd),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF),and fractional shortening,were measured by echocardiography.Meanwhile,106 patients without cirrhosis were selected as a control group by using propensity score matching analysis with a ratio of 1:1.Kaplan-Meier curve,Nelson-Aalen cumulative risk curve,Cox regression,and competing risk analyses were used to evaluate the association of echocardiography-related parameters with decompensated events and death in cirrhotic patients,if appropriate.2.A total of 80 patients with cirrhosis were included in our study,in whom cardiac structure and function,including E/A ratio,LAD,LVDd,IVST,and LVPWT.T test or single factor analysis of variance or nonparametric test and chi-squared or Fisher’s exact tests were used to evaluate the difference of echocardiography-related parameters in different traditional Chinese medicine syndromes of cirrhosis.Results: 1.Patients with cirrhosis had significantly higher LAD(P<0.001),proportion of LAD ≥35 mm(P=0.003),LVEF(P=0.005),and fractional shortening(P=0.006)than those without.In cirrhotic patients,E/A ratio,LAD,LVDd,IVST,and LVPWT were not significantly associated with decompensated events;E/A ≤0.8 was significantly associated with higher cumulative mortality in Kaplan-Meier(P=0.03)and Nelson-Aalen cumulative risk curve analyses(P=0.03),and E/A ≤0.8 was an independent predictor of death in Cox regression(P=0.042)and competing risk analyses(P=0.027),but LAD,LVDd,IVST,and LVPWT were not significantly associated with death.2.Patients with water-damp obstruction in the interior had higher alkaline phosphatase(AKP)(P=0.036),aspartate aminotransferase(AST)(P=0.050),Child-Pugh score(P=0.004),model of end-stage liver disease(MELD)score(P=0.038),and lower albumin(ALB)(P=0.035)and serum sodium(Na)(P=0.004)than those with non-water-damp obstruction in the interior.Patients with damp-heat accumulation had higher proportion of male(P=0.043),proportion of alcohol abuse(P=0.007),total bilirubin(TBIL)(P<0.001),international normalized ratio(INR)(P=0.017),Child-Pugh score(P=0.024),and MELD score(P=0.001)than those with non-damp-heat accumulation.Patients with damp-heat accumulation had higher TBIL(P=0.001)than patients with water-damp obstruction in the interior and spleen-kidney yang deficiency.Patients with water-damp obstruction in the interior had lower ALB(P=0.021)and Na(P=0.031)than patients with damp-heat accumulation and spleen-kidney yang deficiency,and AKP(P=0.021)and LAD(P=0.033)were higher than patients with damp-heat accumulation and spleen-kidney yang deficiency.Both of patients with water-damp obstruction in the interior and damp-heat accumulation had higher Child-Pugh score(P=0.004)and MELD score(P<0.001)than patients with spleen-kidney yang deficiency.Conclusions: 1.E/A ≤0.8 should be incorporated in the prognostic assessment of liver cirrhosis.2.Cirrhotic patients with water-damp obstruction in the interior have larger LAD and may be more prone to diastolic dysfunction.