Correlation of echocardiographic and electrocardiographic changes with liver disease severity in HCV-related liver cirrhosis

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Abstract

Background

Abnormal heart structure and function in patients with cirrhosis include systolic and diastolic dysfunction, electrophysiological changes, and macroscopic and microscopic structural changes.

Objectives

The aim of this study was to investigate the frequency of abnormality of certain echocardiographic and electrocardiographic parameters and their correlation with liver disease severity in hepatitis C virus (HCV)-related liver cirrhosis.

Patients and methods

A total of 66 patients with HCV-related liver cirrhosis with no cardiac or respiratory diseases, diabetes, or hypertension were enrolled in the study. All patients underwent laboratory analysis (international normalized ratio, total bilirubin, creatinine, sodium, and albumin levels), ECG [the corrected QT interval (QTc), PR interval (PRI), QRS interval (QRSI), and heart rate were calculated], and two-dimensional echocardiography by a single operator with measurement of the left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular end-diastolic diameter, left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction, and E/A ratio (E, early maximal ventricular filling velocity and A, late diastolic or atrial velocity). The Child–Pugh, Model for End-Stage Liver Disease (MELD), and MELD-Na scores were calculated for each patient.

Results

Increased LAD, left ventricular end-diastolic diameter, IVST, left ventricular ejection fraction and LVPWT were reported in 32, 1.5, 35, 4.5, and 33% of patients, respectively. The E/A ratio was reduced in 64% of patients. The QTc was prolonged in 17% of patients. The QRSI duration was increased in 4.5% of patients, whereas PRI was normal in all patients. The MELD score has a positive correlation with IVST, LAD, and LVPWT (r=0.6, P<0.0001; r=0.44, P=0.0003; and r=0.51, P<0.0001, respectively) and a negative correlation with the E/A ratio (r=−0.83, P<0.0001). The MELD-Na score correlated positively with IVST, LAD, and LVPWT (r=0.57, P<0.0001; r=0.38, P=0.0015; and r=0.54, P<0.0001, respectively) and negatively with the E/A score (r=−0.68, P<0.0001). The Child–Pugh score correlated positively with IVST, LAD, and LVPWT (ρ=0.41, P=0.001; ρ=0.17, P=0.16; ρ=0.27, P=0.03, respectively) and negatively with the E/A score (ρ=−0.55, P<0.0001). No significant correlation was found between the studied ECG parameters.

Conclusion

Increased LAD, IVST, and LVPWT and reduced E/A ratios are variably present in HCV-related liver cirrhosis patients and are correlated with liver disease severity.

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