Cirrhotic cardiomyopathy(CMC)currently appears as a particular clinical entity occurring during cirrhosis,which is characterized by a constellation of structural,functional, and electrophysiological cardiac abnormalities.Its diagnosis is mainly based on TTE, whose recent advances have led to a paradigm shift in the analysis of cardiac function.
This is a cross-sectional study of patients followed for cirrhosis during the period from 9/1/16 to 5/31/17.Each patient benefited from a clinical examination, an ECG and a cardiac ultrasound: conventional, tissue doppler as well as a 2D Strain study.The diagnosis of CMC was made in the presence of systolic (DS) and/or diastolic (DD) dysfunction.
We included 76 patients with an average age of 54 years [18-79 years] and a sex M/F ratio of 1.4.In 46%,cirrhosis was viral. It was classified CHILD PUGH B in 44.7%. The median MELD score was 11.25 patients (32.9%) were decompensated in the edemato-ascitic mode.QT interval was prolonged in 43.5%.Based on the 2005 consensus diagnostic criteria, DS and DD were present in 5.3% and 51.3%of cirrhotics, respectively. The prevalence of CMC was 53.9%.In addition, the 2D Strain study revealed DS in 13.1%.DD was noted in 32.9% according to the tissue doppler parameters. Based on these data, the prevalence of CMC was 40.8%. The agreement between the consensus definition of CMC and that based on new echocardiographic techniques was moderate (kappa index=0.585; P<0.001). In multivariate analysis, 3 independent predictors of CMC were identified, namely:age (OR 1.05; 95% CI: 1.003–1.103; P<0.039),female gender (OR 3.006; 95% CI:1.029-8.778;P=0.044) and the CHILD PUGH score ≥9 (OR 4.363; 95% CI:1.328–14.331; P=0.015).
Our study has shown that CMC is a common condition, affecting older, female patients with advanced hepatoptathy. TTE in particular 2D strain,could be a promising method for diagnosing this entity, especially by detecting a SD not diagnosed by conventional TTE.
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Publié par Elsevier Masson SAS.