P932Correlation between BNP serum levels and cardiac changes assessed by echocardiography in cirrhotic patients


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Abstract

Purpose: Patients with cirrhosis present with characteristic structural and functional cardiac abnormalities, known as cirrhotic cardiomyopathy. Usual changes include chamber dilatation and systolic and diastolic left ventricular (LV) dysfunction, possibly associated to continuous mechanical stress and neurohumoral factors. Brain natriuretic peptide (BNP) has been related to cardiac dysfunction in heart failure. To the best of our knowledge, the importance of BNP levels in cirrhotic patients has not been studied.Methods: 94 patients (57 males) with liver cirrhosis awaiting liver transplantation were included in this study. Severity of liver disease was estimated by a Model for End Stage Liver Disease (MELD) scores. Echocardiography was undertaken in all patients to obtain LV and right ventricular (RV) diastolic diameters, left atrial (LA) volume, LV ejection fraction (EF) by Simpson's modified rule and diastolic function by E/E' ratio. Pulmonary artery systolic pressure (PAP) was estimated from tricuspid regurgitation. Patients were divided into 2 groups: Group A (61 patients) with BNP≥ 100 pg/ml and Group B (33 patients) with BNP < 100 pg/ml. Student's t test was used for analysis between the groups. Differences were significant when P < .05.Results: All patients had normal LV systolic function. Mean BNP in Group A was: 41 pg/ml (ranging from 4 to 98 pg/ml) and in Group B was 312 pg/ml (ranging from 102 to 1805 pg/ml). Group B comprised older patients compared to Group I and MELD scores were similar for both groups. More expressive hemodynamic changes, with resulting right and left cardiac chamber enlargement, were observed in Group B. Diastolic dysfunction grade I was observed in both groups without significant difference between them (See Table). Conclusion: In this group of cirrhotic patients, increased BNP levels were mainly related to cardiac chamber enlargement, but not with the severity of liver disease, LV systolic and diastolic dysfunctions or higher pulmonary pressures.

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