Diastolic dysfunction in liver cirrhosis

The presence of a hyperdynamic circulation in cirrhotic liver is currently a well established concept. The first studies of cardiac function in patients with cirrhosis suggested the existence of an alcoholic cardiomyopathy. More recently, altered left ventricular response to physiological and/or pharmacological stimuli in patients with post-viral liver cirrhosis has been established, and clinically insignificant diastolic cardiac function has also been observed. Neurohumoral hyperactivity and hyperdynamic circulation, which are associated with chronic exposure to the cardiodepressant substances present in advanced liver disease, play a decisive role in the genesis of this process. The lack of relaxation of the left ventricle and alteration in the pattern of transmitral flow, both of which are characteristics of this clinical entity, are easily detected by echocardiography. The growing evidence of diastolic dysfunction in liver cirrhosis, particularly in decompensated cirrhosis, suggests the clinical importance of the problem, thus introducing the concept of "cirrhotic cardiomyopathy". Greater insight into this phenomenon could help to decrease cardiovascular risk, especially during maneuvers commonly used in the treatment of the complications of liver cirrhosis, such as paracentesis, transjugular intrahepatic portosystemic shunt stent implantation, and liver transplantation.     

Cirrhotic cardiomyopathy: Indian scenario

BACKGROUND: Cirrhotic cardiomyopathy has been reported to be a major cause of morbidity and mortality in liver transplant recipients. However, there is scant data from Asia. With liver transplantation programs gradually being established in the region, Asian hepatologists are bound to face this entity. METHODS: Thirty patients with alcoholic cirrhosis and 30 with cirrhosis of nonalcoholic etiology were enrolled, after excluding those with recent bleeding, gross ascites, severe anemia and other conditions which could alter cardiovascular status. Thirty healthy subjects without cardiovascular risk factors were enrolled as controls. Hepatic function status was assessed by biochemical tests and prothrombin time. Cardiac structural and functional assessment was performed non-invasively using transthoracic echocardiography. RESULTS: Deceleration time was significantly (P < 0.05) prolonged in both the cirrhotic groups (235.03 +/- 44.23 ms and 255.87 +/- 46.16 ms) compared to controls (185.83 +/- 25.04 ms), indicative of diastolic dysfunction in cirrhotic patients. Other parameters, viz. ejection fraction, E : A ratio, left ventricular relative wall thickness, interventricular septal thickness and left ventricular systolic as well as diastolic chamber dimensions did not show statistically significant difference between any of the groups. Cardiac structural and functional parameters were not correlated with the severity of liver dysfunction. There was no statistically significant difference between the alcoholic and nonalcoholic groups. CONCLUSIONS: Asian patients with cirrhosis do have evidence of diastolic dysfunction. Cardiac structural and functional parameters did not correlate with the severity of liver dysfunction. Cardiac dysfunction seemed to be the consequence of cirrhosis itself, rather than of alcohol.     

Validity of N-terminal propeptide of the brain natriuretic peptide in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease

BACKGROUND AND AIMS: Left ventricular diastolic dysfunction has been reported in patients with liver cirrhosis. Although conventional Doppler echocardiography has been used to assess diastolic filling dynamics, this technique is limited in diagnosing left ventricular diastolic dysfunction. The aim of the study was to validate the N-terminal propeptide of the brain natriuretic peptide (NT-proBNP) in predicting left ventricular diastolic dysfunction diagnosed by tissue Doppler imaging in patients with chronic liver disease. METHODS: In 64 patients, left ventricular diastolic dysfunction was classified using tissue Doppler imaging and serum levels of NT-proBNP were measured. RESULTS: Left ventricular diastolic dysfunction was found in 25 of 31 (80.6%) patients with severe liver fibrosis/cirrhosis versus 2 of 8 (25.0%) patients with moderate and 6 of 25 (24.0%) patients with mild liver fibrosis (P<0.001). Mean NT-proBNP levels were 407.1+/-553.4 pg/ml in patients with severe fibrosis/cirrhosis as compared with 60.8+/-54.9 pg/ml and 55.4+/-41.4 pg/ml in patients with mild and moderate fibrosis (P=0.001). NT-proBNP was most accurate in predicting advanced left ventricular diastolic dysfunction with an area under the receiver-operating characteristic curve of 0.90 (95% confidence interval, 0.77-1.0; P<0.001). A cutoff value of greater than 290 pg/ml was highly predictive of advanced left ventricular diastolic dysfunction. CONCLUSION: NT-proBNP is a useful marker in detecting advanced left ventricular diastolic dysfunction in patients with chronic liver disease. Patients with severe liver fibrosis/cirrhosis and NT-proBNP levels exceeding 290 pg/ml should undergo further cardiac evaluation.     

Modification of cardiac function in cirrhotic patients with and without ascites

OBJECTIVES: Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study we investigated cardiac function in cirrhotic patients and in controls. METHODS: A total of 20 cirrhotic patients without previous or ongoing ascites, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy controls were studied by two-dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according to Ganau's criteria. Diastolic function was evaluated by the peak filling velocity of E wave and A wave, E/A ratio, and deceleration time of E wave. The pulmonary systolic arterial pressure was also estimated in patients with tricuspid insufficiency. RESULTS: Right and left atrium and right ventricle diameters were significantly enlarged in cirrhotic patients versus controls. E/A ratio was decreased (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without ascites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systolic arterial pressure was slightly elevated in patients with ascites (35 +/- 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patients) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05). The pattern of left ventricular geometry was normal in the majority of patients. Nitrite and nitrate levels were increased in cirrhotics irrespective of the presence of ascites. CONCLUSIONS: Liver cirrhosis is associated with enlarged right cardiac chambers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites. These changes do not depend on variations in the left ventricular geometry.     

肝硬化门脉高压症患者心脏功能影响因素及其状况评价*

目的 研究肝硬化门脉高压症患者心脏功能状态,探讨其与肝功能的关系,并分析影响左心室舒张功能不全的相关危险因素。方法 我院消化科住院的肝硬化门脉高压症患者126例,其中 Child-Pugh A级76例、B级41例、C级9例,MELD分级≤9分64例和>9分62例。行心电图和超声心动图（包括脉搏波多普勒和组织多普勒成像）检测。采用回归分析影响舒张功能不全的相关因素。结果 在126例患者中,有1例（0.8%）被诊断为左心收缩功能不全,77例（61%）被诊断为左心室舒张功能不全,心电图异常率为65%,其中QTc延长发生率为41%;不同Child-Pugh分级和MELD评分患者左心室舒张功能不全、心电图异常率和QTc延长发生率差异无统计学意义（P>0.05）;Logistic回归分析发现年龄（OR=1.163,95%CI：1.086~1.244）和心率（OR=1.106,95%CI：1.018~1.201）是影响舒张功能不全的相关危险因素。结论 肝硬化门脉高压症患者心功能改变主要以舒张功能减退和电生理异常为主,而与肝病严重程度和大量腹水并无显著相关性。对于年长和心率增快的肝硬化门脉高压症患者,要加强心脏舒张功能的评估,尽早诊断和及时干预可能能改善肝硬化患者的预后。     

Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis?

AIM: To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease.METHODS: A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected. Dobutamine stress echocardiography (conventional and tissue Doppler imaging) was performed. CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress. Therapy interfering with cardiovascular system was suspended 24 h before the examination.RESULTS: Twenty-six patients were analyzed, 17 (65.4%) Child-Pugh A, mean model for end-stage liver disease (MELD) score of 8.7. The global proportion of patients with CCM was 61.5%. At rest, only 2 (7.7%) patients had diastolic dysfunction and none of the patients had systolic dysfunction. Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6 (23.1%) patients and of systolic dysfunction in 10 (38.5%) patients. QTc interval prolongation was observed in 68.8% of the patients and increased pro-BNP levels in 31.2% of them. There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD (P = 0.775, P = 0.532, respectively). Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation (95.0% vs 50.0%, P = 0.028).CONCLUSION: CCM is a frequent complication of cirrhosis that is independent of liver impairment. Stress evaluation should always be performed, otherwise it will remain an underdiagnosed condition.     

肝硬化患者心功能改变及其与肝功能的关系

目的研究肝硬化患者的心脏结构和功能变化,探讨其与肝功能的关系。方法 35例肝硬化患者按照肝功能Child-Pugh分级,A级12例（A组）,B级13例（B组）,C级10例（C组）。20例健康体检者为对照组。利用超声心动图测量静息状态下左室射血分数（EF）、左室直径（Vd）、左房直径（LAs）、右室直径（RVd）、E/A比值、室间隔厚度（IVS）、左室后壁厚度（LVPW）、主动脉瓣环直径（AAO）等指标。结果肝硬化组LAs大于对照组（P=0.000）,A组与B组间比较差异无统计学意义（P=0.248）,A组与C组比较,A组LAs小于C组（P=0.039）,B组与C组比较,B组LAs小于C组（P=0.008）。肝硬化组AAO大于对照组（P=0.000）;IVS肝硬化组大于对照组（P=0.026）;E/A值肝硬化组小于对照组（P=0.002）。结论肝硬化患者存在左心功能不全,以舒张功能不全为主,并与肝功能具有一定关系,提示肝硬化心肌病的存在。当肝硬化患者行心脏二维多普勒超声出现LAs增大、E/A〈1时需注意肝硬化心肌病的可能。     

Valsartan, an angiotensin II type-I receptor blocker, and left ventricular diastolic function--a case report

Impaired diastolic function is related to subjective symptoms, reduced exercise capacity, and poor prognosis in patients with congestive heart failure, and an angiotensin II type-I receptor blocker might have a beneficial effect on diastolic function in such patients with heart failure. A 53-year-old woman underwent valvuloplasty of the mitral valve and later presented with heart failure symptoms, including exertional dyspnea and easy fatigue. Although no pathological changes could be identified by radiography of the chest, electrocardiography, or routine echocardiography, the assessment of diastolic function with Doppler echocardiography revealed left ventricular diastolic dysfunction. Her neurohumoral parameters and left ventricular diastolic dysfunction improved after 1 month of treatment with Valsartan, an angiotensin II type-I receptor blocker, accompanied by improvement of her subjective symptoms. This case implies that angiotensin II type-I receptor blocker could improve left ventricular diastolic dysfunction and that Doppler echocardiography might be useful for detecting diastolic dysfunction in high-risk patients undergoing cardiac surgery.     

Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging

Background: Cirrhotic cardiomyopathy is described as latent cardiac failure. However, it remains to be investigated whether the myocardial dysfunction is present even at rest. Aims: The aim of the present study was to quantify left ventricular function at rest by means of tissue Doppler imaging in patients with cirrhosis and relate the findings to liver status and cirrhosis aetiology. Methods: Forty‐four consecutive patients and 23 age‐matched healthy controls were included. Conventional echocardiographic‐ and tissue Doppler‐derived indices of systolic and diastolic function were obtained. Liver function was quantified by the galactose elimination capacity and clinical stage by the Child–Pugh and MELD scores. Results: Both systolic and diastolic myocardial functions were compromised in the patients at rest. Left ventricular ejection fraction (56.4 ± 6.1 vs. 59.9 ± 3.9%, P<0.02), mean peak systolic tissue velocity (4.6 ± 0.9 vs. 5.6 ± 0.7 cm/s, P<0.001) and mean systolic strain rate (?1.23 ± 0.19 vs. ?1.5 ± 0.14/s, P<0.001) were all reduced in cirrhosis patients. Thirty‐four patients (54%) had diastolic dysfunction, 11 had impaired diastolic relaxation pattern (25%), 12 had the more severe pseudonormal filling pattern (27%) and one had restrictive filling or severe diastolic dysfunction (2%). None of the echocardiographic findings were related to the cirrhosis aetiology. Conclusion: Tissue Doppler imaging during rest detected substantial systolic and diastolic myocardial dysfunction in cirrhotic patients. This supports the existence of a distinct cirrhotic cardiomyopathy.     

Diastolic dysfunction characterizes cirrhotic cardiomyopathy

Aim

Present study aims to study the occurrence of cirrhotic cardiomyopathy and its correlation to hepatorenal syndrome by assessing the cardiac status in patients with cirrhosis of liver and healthy controls.

Methods

Thirty alcoholic cirrhotic, thirty non-alcoholic cirrhotic and thirty controls were enrolled for the study. Cardiac parameters were assessed by color doppler echocardiography. Patients were followed up for twelve months period for development of hepatorenal syndrome.

Results

Mild diastolic dysfunction was present in 18 cirrhotic patients (30%): grade I in fifteen patients and grade II in three. Diastolic dysfunction was unrelated to age; sex and etiology of cirrhosis. Among all the echocardiographic parameters, only deceleration time was found to be statistically significant. Echocardiographic parameters in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies.At one year follow-up, no significant differences were found in survival between patients with or without diastolic dysfunction. Hepatorenal syndrome developed in only two patients and its correlation with diastolic dysfunction was not statistically significant.

Conclusions

Present study shows that although diastolic dysfunction is a frequent event in cirrhosis, it is usually of mild degree and does not correlate with severity of liver dysfunction. There are no significant differences in echocardiographic parameters between alcoholic and non-alcoholic cirrhosis. HRS is not correlated to diastolic dysfunction in cirrhotic patients. There is no difference in survival at one year between patients with or without diastolic dysfunction. Diastolic dysfunction in cirrhosis is unrelated to circulatory dysfunction, ascites and HRS.     

多普勒组织速度成像和实时三维超声心动图评价中晚期肝硬化患者左心室舒张功能的研究

目的探讨应用多普勒组织速度成像（TVI）及实时三维超声心动图（RT-3DE）技术定量评价中晚期肝硬化患者左心室舒张功能的临床应用价值。方法检测中晚期肝硬化患者32例，正常对照组20例，应用多普勒组织速度成像技术检测室间隔及侧壁的二尖瓣环舒张早期峰值速度（Ea），舒张晚期峰值速度（Aa），并计算Ea/Aa比值，将两个位置的平均值作为平均Ea，Aa和Ea/Aa值。应用实时三维超声心动图进行时间-容积曲线分析，测量左室舒张末容积（EDV）、收缩末容积（ESV）、左室射血分数（LVEF）和左室最大充盈速率（PFR）。结果肝硬化组平均Ea降低、平均Aa增高，Ea/Aa比值降低，与对照组比较差异有显著性意义（P〈0.05）。实时三维参数EDV、ESV、和LVEF两组间比较无显著性差异（P〉0.05），与对照组比较PFR明显降低，差异有显著性意义（P〈0.05）。结论肝硬化高动力循环状态下，多普勒组织速度成像及实时三维超声心动图可以对肝硬化患者左室舒张功能减低进行综合的评价，是简便、实用的检测方法。     

Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation

Diastolic dysfunction has been linked to 2 epidemics: atrial fibrillation (AF) and heart failure. The presence and severity of diastolic dysfunction are associated with an increased risk for first AF and first heart failure in patients with sinus rhythm. Furthermore, the risk for heart failure is markedly increased once AF develops. The evaluation of diastolic function once AF has developed remains a clinical challenge. The conventional use of Doppler echocardiography for the assessment and grading of diastolic dysfunction relies heavily on evaluating the relation of ventricular and atrial flow characteristics. The mechanical impairment of the left atrium and the variable cycle lengths in AF render the evaluation of diastolic function difficult. A few Doppler echocardiographic methods have been proved clinically useful for the estimation of diastolic left ventricular filling pressures in AF, but these appear to be underutilized. Several innovative methods are emerging that promise to provide greater precision in diastolic function assessment, but their clinical utility in AF remains to be established. In conclusion, this review provides an up-to-date discussion of the evaluation of diastolic function assessment in AF and how it may be important in the clinical management of patients with AF.     

Hepatopulmonary syndrome and right ventricular diastolic functions: an echocardiographic examination

Aim: Liver functions are affected in the course of cardiac diseases, and similarly, liver diseases affect cardiac functions. Many studies in the literature have shown that left ventricular systolic and/or diastolic dysfunction may develop during chronic liver disease. However, there are limited studies investigating right ventricular functions during chronic liver diseases. Methods: A total of 84 patients who had no systolic and/or diastolic dysfunction in the left ventricle (LV) were evaluated; 46 patients with liver cirrhosis; 10 (21.74%) cirrhotic patients with hepatopulmonary syndrome (HPS) (group 1), 36 (78.26) cirrhotic patients without HPS (group 2), and 38 healthy individuals were treated as control. Results: Right ventricular diastolic dysfunction was determined in all patients of group 1 (100%), 26 of group 2 (72.22 %), and 4 of the controls (10.52%) (P < 0.05). Tricuspid deceleration time (dt) was significantly different between the groups (P < 0.05). In addition, right atrium (RA) diameters, right ventricle (RV) diameters, and RV wall thickness were significantly different between the groups (P < 0.05). Pulmonary artery pressure (P < 0.05) and pulmonary vascular resistance (P < 0.05) were also seen to be higher in group 1 than those in group 2 and control group. Conclusions: Right ventricular diastolic dysfunction rate is high in chronic liver diseases. In the presence of HPS, right ventricular diastolic dysfunction is more remarkable in patients than those without HPS. Right ventricular diastolic dysfunction may result in dilatation and hypertrophy in the right heart.     

Filling patterns in left ventricular hypertrophy: A combined acoustic quantification and Doppler study

Objectives. The purpose of this study was to evaluate the potential of acoustic quantification compared with Doppler echocardiography for assessment of left ventricular diastolic dysfunction.Background. Diastolic dysfunction usually accompanies left ventricular hypertrophy. Although Doppler echocardiography is widely used, it has known limitations in the diagnosis of diastolic abnormalities. The ventricular area-change waveform obtained with acoustic quantification technology may provide an alternative to assess diastolic dysfunction.Methods. Potential acoustic quantification variables (peak rate of area change and mean slope of area change rate during rapid filling, amount of relative area change during rapid filling and atrial contraction) were obtained and compared with widely used Doppler indexes of ventricular filling (isovolumetric relaxation time, pressure half-time, peak early diastolic velocity/peak late diastolic velocity ratio, rapid filling, atrial contribution to filling) ia 16 healthy volunteers and 30 patients with left ventricular hypertrophy.Results. Criteria for abnormal relaxation were present in 68% of patients by acoustic quantification and in 64% of patients by Doppler echocardiography. However, abnormal relaxation was identified in 89% of patients by one or both methods. Acoustic quantification indicated abnormal relaxation in the presence of completely normalized Doppler patterns and in patients with mitral regurgitation or abnormal rhythm with unreliable Doppler patterns.Conclusions. Acoustic quantification potentially presents a new way to assess diastolic dysfunction. This technique may be regarded as complementary to Doppler echocardiography. The combined use of the methods may improve the diagnosis of left ventricular relaxation abnormalities.     

Left atrial velocity vector imaging for the detection and quantification of left ventricular diastolic function in type 2 diabetes

Left ventricular (LV) diastolic dysfunction (DD) is diagnosed by Doppler echocardiography (DE) and Tissue Doppler imaging (TDI). Velocity vector imaging (VVI) evaluates myocardial deformation (strain). We studied left atrial (LA) deformation and volumes by VVI in relation to established Doppler-derived indices of LV diastolic function in diabetic patients. MATERIAL: Using DE and TDI , 87 patients (males 49%; age 60+/-7 years) with type 2 diabetes mellitus were classified as having no (n=60), mild (n=13) or moderate (n=14) DD. RESULTS: LA volume was larger in moderate (72.3+/-22.4 ml) than in mild DD (58.8+/-16.1 ml; p=0.01) and no DD (57.9+/-16.0 ml; p=0.01). LA roof strain distinguished no DD from mild and moderate DD (p=0.0073). Systolic LA strain correlated to total emptying fraction (r=0.70, p<0.0001), and inversely to LA volume (r=-0.35, p=0.0009). A cross-validated analysis of no versus mild or moderate DD expressed by LA strain revealed a positive predictive value of 48% and negative of 84%. CONCLUSION: LA strain by VVI is impaired in patients with type 2 diabetes mellitus and mild or moderate LV DD. LA strain seems of value in distinguishing normal from abnormal diastolic function. VVI offers new information on regional LA function and LA volumes but has too limited discriminative power to detect early LV DD.     

Factors affecting parameters of left ventricular diastolic function derived from Doppler echocardiography

According to the data from left ventricular catheterization as well as M-mode and two-dimensional echocardiography in 36 patients, the influence of left ventricular diameter, systolic function, systolic and diastolic filling pressures on the parameters of left ventricular diastolic function derived from Doppler echocardiography was analysed. The results indicate: (1) the left ventricular end diastolic pressure, rapid filling wave pressure and the ratio of the both significantly affect the Doppler diastolic function parameters; (2) the decrease of the ratio of early-to-late diastolic mitral flow velocities (E/A) is only a manifestation of early stage of left ventricular diastolic dysfunction and the E/A ratio returns to normal (false improving) at advanced stage of left ventricular diastolic dysfunction.     

Management of critically-ill cirrhotic patients

Cirrhotic patients are prone to develop life-threatening complications that require emergency care and ICU admission. They can present specific decompensations related to cirrhosis such as variceal bleeding and hepatorenal syndrome (HRS) or other critical events also observed in the general population such as severe sepsis or septic shock. Clinical management of all these entities requires a specific approach in cirrhosis. Cirrhotic patients have a hyperdynamic circulation with high cardiac output and low systemic vascular resistance in the absence of infection. Circulatory dysfunction increases the susceptibility of critically-ill cirrhotic patients to develop multiple organ failure and attenuates vascular reactivity to vasopressor drugs. HRS, a severe functional renal failure occurring in patients with advanced cirrhosis and ascites, is also secondary to this circulatory dysfunction that leads to an extreme renal vasoconstriction. Moreover, hypotensive cirrhotic patients require a carefully balanced replacement of volemia, since overtransfusion increases portal hypertension and the risk of variceal bleeding and undertransfusion causes tissue hypoperfusion which increases the risk of multiple organ failure. Cirrhotic patients are also at a high risk for development of other bleeding complications and are more susceptible to nosocomial infections. This extreme complexity of critically-ill cirrhotic patients requires a specific medical approach that should be known by general intensivists since it has a negative impact on patient prognosis. This review will focus on the diagnostic approach and treatment strategies currently recommended in the critical care management of patients with cirrhosis.     

Cardiac alterations in cirrhosis: reversibility after liver transplantation

BACKGROUND/AIMS: Liver cirrhosis induces cardiac alterations. We aimed to define these alterations and assess their reversibility after transplantation. METHODS: Cirrhotic patients (n = 40) and controls (n = 15) underwent echocardiography and stress ventriculography. Fifteen cirrhotics were reevaluated 6-12 months after transplantation. RESULTS: 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). CONCLUSIONS: 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.     

超声心动图检查高血压左室肥厚与心电图QT离散度测定的对比研究

目的探讨左心室肥厚和左心功能损伤与QT离散度(QTd)之间的关系。方法对79例高血压病患者进行二维超声及多谱勒心脏检查,同时进行体表心电图QTd测定。结果左心室室壁最大厚度及总厚度积分[1]与QTd呈正相关,QTd与左室内径缩短分数之间无相关性。67.5%的患者存在1项或多项多谱勒左室舒张功能异常指标,QTd与左室舒张功能异常程度密切相关。结论高血压左室肥厚和左室功能损伤表现出有QTd增大,说明高血压左室肥厚超声心动图特征与心电图QTd增大产生机制是一致的。     

Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy

AIMS/HYPOTHESIS: Early determination of myocardial manifestations of diabetes mellitus is of major importance, since myocardial involvement considerably influences the prognosis of diabetic patients. The aim of this study was to investigate whether young patients with insulin-dependent diabetes mellitus and normal systolic left ventricular (LV) function already show a diastolic LV dysfunction and an increased risk of arrhythmias. METHODS: Echocardiography was performed in 87 patients suffering from type I diabetes mellitus, without known cardiac disease and in 87 controls. Patients with a known manifest cardiac disease or a long-term diabetic syndrome were excluded. Morphological parameters were determined using M-mode echocardiography. Doppler echocardiography was used to evaluate parameters of LV diastolic function. The risk of arrhythmia was assessed by means of electrocardiography, heart rate variability, and late potential analysis. RESULTS: The left atrial and ventricular dimensions and systolic functional parameters of all patients were normal. A diastolic dysfunction with a reduction in early diastolic filling, an increase in atrial filling, an extension of isovolumetric relaxation and deceleration time was documented in diabetic patients, as well as an increased number of supraventricular and ventricular premature beats. CONCLUSION: Even young patients with diabetes mellitus suffer from a diastolic dysfunction while systolic ventricular function is normal. Therefore, echocardiography with measurements of diastolic functional parameters appears to be a sensitive method for evaluating the manifestation and course of early diabetic cardiomyopathy.