Analyses of left ventricular function using speckle tracking in patients with livercirrhosis evaluated for liver transplantation

Background: Cirrhotic cardiomyopathy is an abnormal heart function including systolic and diastolic dysfunction. This cardiomyopathy is mostly latent and gets clinical significant when patients are subjected to stress (e.g. inflammation, hemorrhage, surgery). This study analyses the role of speckle tracking echocardiography (STE) as prognostic marker for cirrhotic patients.

Methods: 111 (39w, 72 m) patients with liver cirrhosis evaluated for liver transplantation were included. Clinical and laboratory data were collected retrospectively. Longitudinal 2D strains of left and right ventricle were analyzed in apical four-chamber view.

Results: In cirrhotic patients, longitudinal average strain as well as from the left as the right ventricle correlated significantly inverse with INR and direct with gGT. Further the longitudinal average strain of the right ventricle correlated direct with MELD score. The univariate analysis shows in addition to the classical parameters longitudinal strain as prognostic factor. Interestingly, we observed in multivariable Cox regression analysis left ventricular apical septal strain as independent predictor of survival. Multivariable time-to-event analysis of patients with Child C, MELD score and left ventricular average strain were identified as independent predictor of survival. Longitudinal left ventricular stain showed a non significant increase in Child class A to Child class B, followed by a significant decrease to Child class C.

Conclusions: Speckle tracking is an important non-invasive tool to evaluate cardiac dysfunction and the extent of the hyperdynamic circulation in patients with liver cirrhosis. Furthermore, speckle tracking might predict outcome, mainly the liver transplant-free survival.