Prevalence of cirrhotic cardiomyopathy in patients with cirrhosis of liver : a tertiary hospital experience

Abstract

Cirrhotic cardiomyopathy is impaired contractile responsiveness to stress, diastolic dysfunction and electrophysiological abnormalities in the absence of known cardiac disease in cirrhotic patients.  This Descriptive case series study was conducted in sree balaji medical college and hospitals. This study included 74 consecutive cases of cirrhosis of liver of either sex above 14 years of age. Firstly, resting ECG was done in all the patients. QTc values were calculated from lead II. QTc interval of >0.44 sec were considered as prolonged. Systolic dysfunction was assessed by ejection fraction (value of >55% was considered as increased). Diastolic dysfunction manifested by reduced E/A ratio (<1 was considered as decreased). Thirdly, all patients had determination of proBNP levels. The presence of cirrhotic cardiomyopathy was confirmed by abnormal ECG or echocardiography, along with proBNP abnormalities. Statistical package for social sciences (SPSSTM) version 16 was used for data processing purpose. Means ±Standard Deviation of age and pro BNP levels were calculated. Frequency and percentage were computed for cirrhotic cardiomyopathy in cirrhosis patients.  A total of 74 patients were selected for this study, out of which 41 (55.41%) were male and 33 (44.59%) were female. The mean age was 46.2 years (± 10.8 SD). Out of 74 patients 9 (12.2%) belonged to child Pugh A, 29(39.2%) to child-Pugh B and 36(48.6%) in child-Pugh C. Elevated pro BNP was present in 42(56.8%) cases, E/A ratio < 1 in 15 (20.3%) cases, prolong QT interval (>0.44sec) in 16 (21.6%), Ejection fraction (EF) > 0. 55 was present in 25 (33.8%) patients. Cirrhotic cardiomyopathy was present in 33(44.6%) cases. A strong relation was found between cardiomyopathy and severity of cirrhosis of liver (p=0.001), pr0-Bnp levels (p=0.003), QTc > 44 sec (0.004), Ejection fraction > 55% (0.004) and E/A ratio < 1 (p=0.005). Cirrhotic cardiomyopathy was present in a sizeable proportion of cirrhotic patients, more so in the later stages of cirrhosis of liver.