CHANGES IN CARDIAC FUNCTION IN PATIENTS WITH DECOMPENSATED CHRONIC LIVER FAILURE

Introduction and Objectives

Cirrhotic cardiomyopathy is cardiac dysfunction, recently recognized as a clinical entity, present in up to 50% of liver cirrhosis in the absence of other heart diseases. Cirrhotic cardiomyopathy is characterized by a decrease in the contractile response of the heart in patients with CH, associated with the presence of an alteration in diastolic relaxation and electrophysiological alterations at rest, all in the absence of known heart disease and regardless of the etiology of liver disease. Hemodynamic and electrophysiological studies have made it possible to document alterations in cardiac behavior in 25 and 40-60% of patients with liver cirrhosis, respectively. Objective: Determine the alterations in cardiac function in patients diagnosed with decompensated chronic liver failure.

Material and methods

Descriptive, observational, cross-sectional and prospective study, carried out all the patients with decompensated liver cirrhosis who attended the Central Military Hospital from January 2021 to September 2021 and who underwent a laboratory study, echocardiogram, electrocardiogram, chest X-ray and laboratory studies. The mean, standard deviation and absolute and relative frequencies will be used for the quantitative variables for the statistical calculation. The statistical package SPSS version 20 will be used.

Results

Eleven older patients with a diagnosis of decompensated chronic liver failure were included. A new study carried out on the same basis as CANONIC, allowed to clarify the dynamic and evolutionary character of patients with ACLF, determining the average mortality at 28 and 90 days, according to the number of compromised organs. Thus, the presence of ACLF-1 determines a risk of death at 28 and 90 days of 18 and 39%, respectively, a figure that increases in ACLF-2. 54.5% were men, the average age 54.2 years ± 10.3, 27.3% had arterial hypertension and 9.1% DM2, the etiologies were by enol in 54.5%, HAI 18.2%, PBC 18.2% and 9.1% by MAFLD. Mean arterial pressure was 77.0 ± 8.1, QTc 449.9 ± 57.6, and HR 78.54. The Child-Pugh scale had mainly C score values in 36.4% of the cases, followed by 27.3% in 12-point scores, scores of 10, 11 and B had only one case, respectively (9.1%). The MELD score was 10 at 40 points, 27.3% of the patients reported 18 points, a case similar to the MELD-NA from 13 to 40, with 18.2% of the patients at 21 points and a similar percentage at 29 points. CLIF score was distributed in 54.5% in 1, 27.3% in 2 and 18.2% in 0. PSAP had a mean of 31.2 ± 8.3 and diastolic dysfunction, it appeared in two cases as isovolumic relaxation and in two as a slow relaxation pattern, the other patients had various types of diastolic dysfunction, the natriuretic peptide was 314.1 pg / ml with a range of 13.1 to 1270.0 pg / ml. Troponin in 45.5% of the cases was less than 0.1ng / L, in 27.3% <0.05 ng / L, in 18.2% <0.01 ng / L and 9.1% was 0.026 ng / L. CK-MB in 90.9% was less than 1.0 U / L and in 9.1% it was 1.8 U / L. TAPSE had an average of 23.2MM ± 4.3.

Discussion

30% of these patients died in this hospitalization With an average of 30 ± 10 days hospitalized. The decompensating cause was 72% ascites, 20.5% hepatorenal syndrome and 7.5 other causes, including gastrointestinal bleeding. Observing that with this number of patients, there is a great implication in mortality and in the number of days of hospital stay.

Conclusions

It was possible to characterize cardiac function alterations in patients with a diagnosis of decompensated chronic liver failure, being more affected patients with arterial hypertension, etiology attributable to alcoholism, Child-Pugh C, MELD of> 27 points and MELD-NA of> 18 points and mainly CLIF 1 and PSAP of 31. It is expected to increase the number of patients to obtain greater clinical relevance.

The authors declare that there is no conflict of interest.