Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria. Alterations in ultrasonographic parameters of both left and right ventricles before and after stress

Background Prevalence of cirrhotic cardiomyopathy (CC) remains controversial. Several guidelines have been proposed for its assessment. Aim To estimate the frequency of CC by using all of the proposed diagnostic criteria, to describe the whole spectrum of cardiac alterations and investigate the role of stress in unmasking latent cases of CC. Methods Ninety consecutive patients were recruited. CC was evaluated by using the Montreal, the 2009 and 2019 criteria. Dobutamine stress test was also performed. Results LVDD was identified in 72(80%), 36(40%) and 10(11.1%) patients based on the above criteria, respectively. None of the patients had right ventricular systolic dysfunction, neither at rest, nor after stress. Stress test revealed left systolic dysfunction in 4(4.5%) patients. According to 2019 criteria, presence of LVDD was not associated with gender, etiology, or staging of liver disease. Patients with LVDD had longer QTc (p=0.002), larger LAvol (p=0.0001), lower TAPSE(s) (p=0.012), lower SRV(s) (p=0.0001) and lower ΔCI (p=0.009) compared to those without. Patients with Child-B/C had longer QTc (p=0.004), higher BNP (p=0.016), higher E/e’ (p=0.0001) and higher E/e’(s) (p=0.003), compared to Child-A patients. A significant correlation was demonstrated between Child-Pugh score and E/e’ (p=0.0001), or E/e’(s) (p=0.002). Conclusions In accordance with the recent guidelines the prevalence of CC seems to be lower. LVDD is the predominant feature of CC and aggravates along with the severity of liver disease. After dobutamine administration several sonographic variables exacerbate, particularly in Child-B/C patients, indicating a potential higher risk for clinical heart failure during stressful invasive interventions.