Disfunción ventricular en pacientes con cirrosis hepática

Background: Cardiopulmonary abnormalities are frequent in patients with advanced stages of liver and lung diseases. Several studies have shown some degree of increased ventricular wall thickness, diastolic dysfunction, and abnormal systolic response to stress, without any relation to the etiology of the hepatic disease. Objective: To know the echocardiographic profile of patients with hepatic cirrhosis and its relation with the etiology, the Child-Pugh classification and the hepatopulmonary syndrome frequency. Patients and method: 120 patients with liver disease were consecutively included in four groups of 30 patients each one: alcoholic-nutritional hepatic cirrhosis, primary biliary cirrhosis, autoimmune cirrhosis, and post-necrotic cirrhosis. They were divided accordingly to the Child-Pugh classification. A contrast echocardiogram was obtained in all cases. Results: An increase in the end systolic diameter "E" wave-interventricular septum distance of the left ventricle and the higher mitral valve opening correlated with the worst functional Child-Pugh classification. In alcoholic nutritional hepatic cirrhosis we found the biggest left ventricle end systolic dimensions, as well as right ventricle diastolic diameter and right/left ventricle rate. Hepatopulmonary syndrome was found in 20 patients (16.7%). Conclusion: Right cardiac chamber enlarged in cirrhosis is probably the consequence of an increased preload. Left ventricle ejection fraction at rest is preserved, however, the increased left ventricle end systolic diameter could mean a reduction of the contractile reserve, as can be observed in our cases.