Key result
Left ventricle diastolic dysfunction was more frequent in cirrhotic patients with ascites, although mean MELD scores did not differ between patients with and without diastolic dysfunction.
Why the study?
To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing literature.
Does the severity of liver cirrhosis correlate with left ventricle diastolic dysfunction?
Systematic Review
Does the severity of liver cirrhosis correlate with left ventricle diastolic dysfunction?
Left ventricle diastolic dysfunction is a frequent complication in liver cirrhosis, particularly in patients with ascites, though it does not appear to correlate with MELD scores.
Answers are grounded in this paper and cite their sources.
LVDD screening merits consideration in advanced cirrhosis; confirms correlation with liver failure severity across studies.
BACKGROUND: Liver cirrhosis is a chronic hepatic disease which is associated with cardiovascular abnormalities. Hyperdynamic circulation in liver cirrhosis causes functional and structural cardiac alterations. The prevalence of left ventricle diastolic dysfunction (LVDD) in cirrhotic patients ranges from 25.7% to as high as 81.4% as reported in different studies. In several studies the severity of diastolic dysfunction (DD) correlated with a degree of liver failure and the rate of dysfunction was higher in patients with decompensated cirrhosis compared with compensated. Future directions of comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients. AIM: To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing literature. METHODS: Through January and February of 2019 at Vilnius University we conducted a systematic review of the global existing literature on the prevalence of left ventricle diastolic dysfunction in patients with liver cirrhosis. We searched for articles in PubMed, Medline and Web of science databases. Articles were selected by using adequate inclusion and exclusion criteria. Our interest was the outcome of likely correlation between the severity of cirrhosis [evaluated by Child-Pugh classes, Model For End-Stage Liver Disease (MELD) scores] and left ventricle diastolic dysfunction [classified according to American Society of Echocardiography (ASE) guidelines (2009, 2016)], as well as relative risk of dysfunction in cirrhotic patients. Subgroup analyses were performed to evaluate the ratio and grades of left ventricle diastolic dysfunction with respect to cirrhosis severity. There was no difference between mean MELD scores in patients with and without diastolic dysfunction and in different diastolic dysfunction groups. In all studies diastolic dysfunction was more frequent in patients with ascites. CONCLUSION: This systemic analysis suggests that left ventricle diastolic dysfunction is an attribute of liver cirrhosis which has not received sufficient attention from clinicians so far. Future suggestions of a comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients and give hint for better understanding of the left ventricle diastolic dysfunction pathogenesis in liver cirrhosis.
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Stundienė et al. (2019) conducted a systematic review in Liver cirrhosis. Severity of liver cirrhosis was evaluated on Prevalence of left ventricle diastolic dysfunction and correlation with cirrhosis severity (p=<0.001). Left ventricle diastolic dysfunction was more frequent in cirrhotic patients with ascites, although mean MELD scores did not differ between patients with and without diastolic dysfunction.
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