Ultrasonoscopic description of the structure and function of the heart in patients with syntropic cirrhotic cardiomyopathy and their features depending on the main liver disease severity

Abstract

Liver cirrhosis is usually accompanied by extrahepatic syntropic lesions, among which cardiomyopathy is one of the most common. To date, both the definition and the criteria of syntropic cirrhotic cardiomyopathy have been formulated. However, information on the exploration of the relationship between the changes of the heart in these patients and the class of severity of cirrhosis in is not found in the available literature. Aim. To describe the ultrasound features of the heart in patients with syntropic cardiomyopathy and to find out their features related to the severity of the main liver disease. Material and Methods. After receiving the consent on conduction of the complex examination in randomized way with the previous stratification on the presence of the cirrhosis there were selected 603 patients (445 men, 158 women, age 49,2±10,6 years). The patients were stratified into two subgroups: 113 patients with cirrhosis and without circulatory system disorder of which 23 patients were randomly included in the comparison group; 490 patients with cirrhosis and extrahepatic circulatory system disorder from which, in a randomized manner we chose the patients for the experimental group - 66 patients with cirrhosis and cardiomyopathy). The cirrhotic patients in the experimental group were classified according to the criteria of C. G. Child and R. N. Pugh (23 patients in class A, 22 - in B and 21 - in C). The control group consisted of 19 healthy volunteers of the same gender and age. Ultrasound was conducted according to the standard procedure - lying on the left side using the "SAMSUNG H-60" Device. The obtained material was processed using the EViews program (Quantitative Micro Software). Results and Discussion. Our analysis made it possible to reveal a number of structural characteristics of cardiomyopathy: significantly lower end-diastolic volume of the right ventricle and significantly higher end-diastolic left ventricular volume; sizes of right and left ventricle in the systole; sizes of the left ventricle and interventricular septum, which was manifested by pathological myocardial remodeling; normal systolic function at rest in patients of the experimental group achieved due to high stroke volume and, accordingly, high minute blood volume and cardiac indices; diastolic dysfunction and the high C. Tei index. we also found that the structure and function of the heart varied along with the increase of the cirrhosis severity. Namely, the interventricular septum and the left ventricle were found to be hypertrophied and subsequently dilated; systolic function in all classes - within normal ranges, and diastolic - sharply decreased in case of the cirrhosis exacerbation. All this is as a result of the overload of the heart with increasing blood volume and disturbance of metabolic processes in the myocardium. Conclusions. Patients with liver cirrhosis and syntropic cardiomyopathy have specific changes in the structure of the myocardium resulting in the occurrence of pathologic variants of heart remodeling, normal systolic function at rest and diastolic dysfunction. The structure and function of the heart is related to the liver cirrhosis severity - the revealed structural and functional disturbances increase along with exacerbation of the underlying liver disease. The obtained information will help to optimize the diagnosis and treatment of patients with liver cirrhosis and syntropic cardiomyopathy.

Keywords

• liver cirrhosis, cardiomyopathy, heart remodeling, diastolic dysfunction