Key result
Liver cirrhosis was associated with significantly expanded myocardial extracellular volume fraction compared to healthy controls (31.6% vs 25.4%), which normalized one year after liver transplantation.
Why the study?
Although cardiac dysfunction is increasingly recognized in liver cirrhosis, the presence of structural alterations such as diffuse myocardial fibrosis and the effects of liver transplantation remain unclear.
Does liver transplantation reverse myocardial structural (extracellular volume expansion) and functional (augmented systolic function) changes in patients with cirrhotic cardiomyopathy?
Observational (n=53)
No
Does liver transplantation reverse myocardial structural (extracellular volume expansion) and functional (augmented systolic function) changes in patients with cirrhotic cardiomyopathy?
Absolute Event Rate: 31.6% vs 25.4%
p-value: p=<0.001
Myocardial extracellular volume expansion and augmented resting LV systolic function are characteristic structural and functional components of cirrhotic cardiomyopathy that normalize one year after liver transplantation.
Suggests potential reversibility of cirrhotic cardiomyopathy after transplant; hypothesis-generating and requires prospective confirmation.
BACKGROUND: Cardiac dysfunction is increasingly recognized in patients with liver cirrhosis. Nevertheless, the presence or absence of structural alterations such as diffuse myocardial fibrosis remains unclear. We aimed to investigate myocardial structural changes in cirrhosis, and explore left ventricular (LV) structural and functional changes induced by liver transplantation. METHODS: This study included 33 cirrhosis patients listed for transplantation and 20 healthy controls. Patients underwent speckle-tracking echocardiography and cardiovascular magnetic resonance (CMR) with extracellular volume fraction (ECV) quantification at baseline (n = 33) and 1 year after transplantation (n = 19). RESULTS: : 67.8 ± 6.9% in cirrhosis vs 63.4 ± 6.4% in healthy controls, P = 0.027; echocardiographic GLS: - 24.2 ± 2.7% in cirrhosis vs - 18.6 ± 2.2% in healthy controls, P < 0.001). No significant differences in LV size, wall thickness, mass index, and diastolic function between cirrhosis patients and healthy controls were seen (all P > 0.1). Only one of the cirrhosis patients showed late gadolinium enhancement. However, cirrhosis patients showed a higher ECV (31.6 ± 5.1% vs 25.4 ± 1.9%, P < 0.001) than healthy controls. ECV showed a positive correlation with Child-Pugh score (r = 0.564, P = 0.001). Electrocardiogram-based corrected QT interval was prolonged in cirrhosis (P < 0.001). One-year post-transplantation, echocardiographic LV-GLS (from - 24.9 ± 2.4% to - 20.6 ± 3.4%, P < 0.001) and ECV (from 30.9 ± 4.5% to 25.4 ± 2.6%, P = 0.001) moved to the normal ranges. Corrected QT interval decreased after transplantation (from 475 ± 41 to 429 ± 30 msec, P = 0.001). CONCLUSIONS: Myocardial extracellular volume expansion with augmented resting LV systolic function was characteristic of cirrhotic cardiomyopathy, which normalizes 1-year post-transplantation. Thus, myocardial extracellular expansion represents a structural component of myocardial changes in cirrhosis.
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Kim et al. (2020) conducted an observational in Liver cirrhosis (n=53). Liver cirrhosis vs. Healthy controls was evaluated on Extracellular volume fraction (ECV) (p=<0.001). Liver cirrhosis was associated with significantly expanded myocardial extracellular volume fraction compared to healthy controls (31.6% vs 25.4%), which normalized one year after liver transplantation.
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