Liver cirrhosis is still a common disease in our country, and the occurrence of cardiac function abnormalities in cirrhotic patients has gained recent attention although clinical symptoms of cardiac impairment et rest are often not appear.
Objective: This work was done to study cardiac function in Egyption patients with non-alcoholic liver cirrhosis with and without ascites by using Doppler echocardiography.
Methods: This study included 30 cirrhosis patients classified into two groups, 15 patients with no ascites (non ascites group), and 15 patients with moderate to sever ascites at the time of the study (ascites group). The study also included 10 age and sex matched healthy volunteers served a control group. All patients and controls were subjected to detailed history taking, careful clinical examination, chest X-ray, resting ECG, laboratory investigations, abdominal ultrasonography and echo-doppler study.
Results: This study showed that in presence of ascites, the left ventricular diameters and volumes are significantly decreased as compared to non ascitic patients (P<0.01) and control (P<0.05), in time the right ventricular diameters and volumes showed no significant difference in the different study groups except the right ventricular and systolic volume which is significantly smaller in patients with ascites (P<0.05). Also, this study showed significantly increased systolic function of both right and left ventricles, in the presence of ascites, as assessed by fractional shortening (FSH%) and ejection fraction (EF%) and by tricuspid annular plane systolic excursion (TAPSE) for the right ventricle(P<0.05), this may attributed to the presence of hyperdynamic circulation in ascites patients eith decreased in systolic and diastolic blood pressure (after load) and increase in heart rate, which found to be significant in ascites patients as compared to both non ascites patients and controls. Also, in presence of ascites, the left ventricular wall stress was found to be significantly decreased as compared to both non ascitic patients and controls (P<0.05). On the other hand, diastolic function of both right and left ventricles was significantly impaired in presence of ascites as compared to non ascitic patients and controls(P<0.01). However ascites showed no more changes in diameters of both right and left atrium and septal (P<0.01), and posterior wall thickness (P<0.05), which is significantly increased in cirrhotic patients without ascites.
Conclusion: Echocardiographic evaluation of cardiac dimentions and systolic and diastolic function, should be done for patients with liver cirrhosis to predict as early as possible the early signs of cardiac function impairment specially for those patients undergoing liver transplantation, shut implantation and a major surgery.
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