The Effect of Liver Cirrhosis Severity on Left Ventricular Systolic and Diastolic Functions

Background: Alteration of cardiovascular functions in patients with liver cirrhosis has been described and it correlates with severity of hepatic failure. But cardiac function by conventional echocardiography has limitations and cardiac decompensation occurs when the heart is challenged. Aim: To evaluate cardiac systolic and diastolic functions in patients with liver cirrhosis by conventional Doppler echocardiography and tissue Doppler image (TDI) and correlate the results with severity of cirrhosis based on Child-Pugh score. Methods: 624 patients with liver cirrhosis divided into 3 groups according to Child pugh score then systolic and diastolic functions were evaluated with conventional echo (2D, PW Doppler and MM and by TDI (Sm, Em and Am) then E/Em was calculated. Results: By conventional echo LV dimensions and systolic function were normal and hyperdynamic in Child C, diastolic dysfunction was diagnosed in 67% and difference between 3 groups was insignificant, by TDI diastolic dysfunction was diagnosed in 89% in cirrhotic patients and there were statistically significant systolic dysfunction in the form of lower Sm (p=0.001) and there was significant +ve correlation between severity of cirrhosis and Sm and diastolic dysfunction in the form of lower Em (p=0.005) and there was significant +ve correlation between severity of cirrhosis and Em also higher E/Em (p=0.0001) with significant –ve correlation. Conclusion: TDI is simple, non invasive, bedside, being cheap and more accurate test that can be used to detect early subclinical left ventricular systolic and diastolic dysfunction in cirrhotic patients especially in Child B cirrhosis.