Key result
Myocardial work and cirrhotic cardiomyopathy fail to predict major adverse clinical outcomes in decompensated cirrhosis.
Cohort (n=96)
Yes
Myocardial work is decreased in cirrhotic cardiomyopathy but does not independently predict adverse clinical outcomes beyond liver disease severity and diastolic dysfunction.
Myocardial work indices should not yet guide prognosis in decompensated cirrhosis; leaves open their incremental value beyond MELD-Na and E/e' in prospective studies.
Background Myocardial work (MW), an emerging measure of cardiac function, has not been assessed in cirrhotic cardiomyopathy (CCM) unlike global longitudinal strain (GLS). Aims To evaluate MW in cirrhosis with transthoracic echocardiography (TTE) and dobutamine stress echocardiography (DSE); to study association of MW and CCM with a composite study outcome (one or more of acute kidney injury/hepatorenal syndrome, refractory ascites, cardiac failure, death); to assess the utility of cardiac biomarkers (NT-pro-BNP and cardiac troponin T) in the diagnosis of CCM; and to re-assess cardiac function at 12 months of LT. Methods Design : Prospective study. Participants : Decompensated liver cirrhotic patients with ascites and those undergoing liver transplant (LT) assessment from January 2021 to August 2022 with a 12-month follow-up. Study : TTE- and DSE-reported systolic and diastolic parameters as well as GLS and MW indices were calculated. Results 96 patients, mean ± SD age 56 ± 11 years (58% male; 59% alcohol misuse) with Model for End-stage Liver Disease Sodium (MELD-Na) 17 ± 7 were studied. During the follow-up, 16 underwent LT; 53 developed the study outcome. CCM was diagnosed in 26 (27%), and it had no association with study outcome. MW was decreased in patients with CCM, and there was no augmentation of GLS or MW on DSE. MELD-Na. GLS, MW indices and septal E/e’ were higher in patients meeting the study outcome. MELD-Na and septal E/e’ were independent predictors of the study outcome. There was no association between biomarkers and CCM. Ten patients evaluated post LT demonstrated significant reductions in GLS and MW. Conclusions MW was decreased in patients with CCM. Neither MW indices nor a diagnosis of CCM was predictive of the study outcome. Liver disease severity measured by MELD-Na score and E/e’ were independent predictors of the study outcome. Although MW is a load-independent measure, in this study, it did not add to the diagnosis CCM more than GLS. Further large-scale studies are required to establish the role of MW in evaluation of patients with liver cirrhosis.
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Ramachandran et al. (2026) conducted a cohort in Decompensated liver cirrhosis (n=96). MELD-Na score vs. Lower MELD-Na score was evaluated on Composite clinical outcome (acute kidney injury/hepatorenal syndrome, refractory ascites, cardiac failure, death) (HR 1.076, 95% CI 1.018-1.136, p=0.009). In patients with decompensated cirrhosis, neither myocardial work indices nor a diagnosis of cirrhotic cardiomyopathy predicted the composite clinical outcome, whereas MELD-Na score (HR 1.076) and septal E/e' (HR 1.179) were independent predictors.
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