Cirrhotic cardiomyopathy was diagnosed in 26.4% of cirrhotic patients, associated with MASLD etiology but not linked to liver disease severity or mortality.
Does the presence of cirrhotic cardiomyopathy predict all-cause mortality in patients with liver cirrhosis?
Cirrhotic cardiomyopathy is present in about 26% of cirrhotic patients and is associated with MASLD etiology, but does not predict 24-month all-cause mortality.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Patients with liver cirrhosis (LC) exhibit cardiac dysfunction characterized by increased cardiac output at rest with impaired inotropic reserve, decreased afterload and diastolic dysfunction, an entity referred to as cirrhotic cardiomyopathy (CCM). Diagnosis of CCM is based on echocardiographic criteria that examine both the systolic and diastolic component of cardiac dysfunction at rest and namely left ventricular ejection fraction (LVEF) 50% or global longitudinal strain (GLS) 18% for the systolic criterion and the established 2016 diagnostic criteria for diastolic dysfunction for the diastolic one. However, only few studies have examined the diagnostic and prognostic utility of those criteria. Purpose We sought to associate the presence of CCM with the etiology and severity of liver cirrhosis as well as with the prognosis of cirrhotic patients. Methods A total of 87 patients with LC in stable clinical condition and without coronary artery disease, valvular heart disease and heart failure of alternative etiology (including alcoholic cardiomyopathy) were prospectively enrolled. Patients underwent comprehensive echocardiographic examination, and the acquired images were analyzed off-line by a blinded expert on echocardiography. The diagnosis of CCM was based according to the latest 2020 Cirrhotic Cardiomyopathy Consortium criteria. Model for end stage liver disease (MELD) score was calculated from obtained blood examinations using the Mayo-Clinic formula and was used to define LC severity. Patients were followed up for a total of 24 months and the primary endpoint was all cause mortality which was available in 77 out of 87 patients. Results CCM was diagnosed in 23 (26.4%) patients with the systolic criterion being fulfilled in 9 (10.3%) and the diastolic criterion in 15 (17.2%) patients. Patients with CCM were older (61.7 vs 56.4, p=0.009) years, but did not differ significantly for the sex, the systolic blood pressure, the heart rate, the cardiac output and the MELD score. Patients with CCM were more likely to have LC resulting from metabolic syndrome associated liver disease (MASLD) (47.4% vs 17.5%, p=0.008). The primary endpoint was met in 31 (40.3%) patients, 9 (42.9%) with CCM and 22 (39.3%) without CCM (p0.05). According to the survival analysis, CCM was not associated with worse patient survival (Log Rank test, p0.05) (figure 1). This lack of association was maintained in multivariate Cox regression hazard models that included CCM status, age, MASLD etiology, and MELD. Conclusions Diagnosis of CCM according to the more recent criteria was made in about one out of four cirrhotic patients. CCM was associated with MASLD related etiology of LC, but not with the severity of LC or patient prognosis.Figure 1
Dimitroglou et al. (Sat,) reported a other. Cirrhotic cardiomyopathy was diagnosed in 26.4% of cirrhotic patients, associated with MASLD etiology but not linked to liver disease severity or mortality.