Key result
Fatigued primary biliary cirrhosis patients had a significantly increased cardiac torsion-to-shortening ratio (0.70 vs 0.46, P=0.002) compared to controls, indicating accelerated cardiac aging.
Why the study?
Do fatigued early-stage primary biliary cirrhosis patients have alterations in cardiac torsion and strain compared to nonfatigued patients and healthy controls?
Cross-Sectional (n=23)
Blinded analysis
No
Do fatigued early-stage primary biliary cirrhosis patients have alterations in cardiac torsion and strain compared to nonfatigued patients and healthy controls?
Absolute Event Rate: 0.7% vs 0.46%
p-value: p=0.002
Fatigued patients with early-stage primary biliary cirrhosis exhibit abnormal cardiac torsion-to-shortening ratios indicative of subendocardial dysfunction and accelerated cardiac aging, which correlates with autonomic dysfunction.
Fatigue may link to cardiac aging markers in PBC; hypothesis-generating and should not yet alter management.
The autoimmune liver disease primary biliary cirrhosis (PBC) is associated with life-altering fatigue in ∼50% of patients. Previous work suggests that fatigued PBC subjects have evidence of autonomic dysfunction and may be at a higher risk of sudden cardiac death. The manifestation of this risk is not clear. This pilot study investigated whether alterations in cardiac torsion and strain could be detected in fatigued or nonfatigued early-stage PBC patients. We performed cardiac tissue tagging and anatomical cine-imaging in 13 early-stage PBC patients (including 7 with significant fatigue) and 10 control subjects to calculate cardiac torsion and strain throughout systole and diastole. From the cardiac tagging, we calculated the torsion-to-shortening ratio (TSR), a measure of subepicardial torsion exerting mechanical advantage over subendocardial shortening. Autonomic function testing was performed to evaluate baroreceptor effective index on standing. TSR was markedly increased in the fatigued PBC patients (0.70 ± 0.13) compared with both controls (0.46 ± 0.11, P = 0.002) and nonfatigued PBC patients (0.44 ± 0.12, P = 0.003). Decreased baroreceptor effective index on standing strongly correlated with increased TSR within the whole PBC group (r = -0.71, P = 0.007). Fatigued PBC patients demonstrate a redistribution of myocardial strain characteristic of a reduced relative contribution to contraction from the subendocardium. This is analogous to the changes found in healthy aging for subjects ∼16 yr older than the fatigued PBC patients. Hence the hearts of fatigued PBC patients may be subject to processes of accelerated aging.
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Hollingsworth et al. (2012) conducted a cross-sectional in Primary biliary cirrhosis (n=23). Fatigued primary biliary cirrhosis vs. Healthy controls and nonfatigued PBC was evaluated on Torsion-to-shortening ratio (TSR) (p=0.002). Fatigued primary biliary cirrhosis patients had a significantly increased cardiac torsion-to-shortening ratio (0.70 vs 0.46, P=0.002) compared to controls, indicating accelerated cardiac aging.
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