EVIDENCE OF FUNCTIONAL AND STRUCTURAL CARDIAC ABNORMALITIES IN CIRRHOTIC-PATIENTS WITH AND WITHOUT ASCITES

Cirrhosis is associated with cardiovascular abnormalities, Scanty info rmation is available as to whether these include left ventricle diasto lic dysfunction and wall thickness increase. To this aim in 27 cirrhot ic patients with tense ascites, 17 cirrhotic patients with previous ep isodes of ascites (not actual), and 11 controls we investigated by ech ocardiography and echocolor Doppler left ventricle diastolic function (E wave, A wave, E/A ratio, deceleration time of E wave), systolic fun ction (ejection fraction), and wall thickness (left ventricle posterio r wall thickness + interventricular septum thickness) along with neuro humoral variables. All measurements (supine position) were repeated af ter total paracentesis (10.7 +/- 0.6 L of ascites) in ascitic patients , Both in patients with and without ascites E/A ratio was reduced as c ompared with controls (0.93 +/- 0.07 and 0.97 +/- 0.06 vs. 1.18 +/- 0. 08, P < .05 while left ventricle wall thickness was increased (18.6 +/ - 0.6 and 20.1 +/- 0.8 vs, 17.2 +/- 0.7, P < .05 and P < .01, respecti vely), irrespective of the postviral or alcoholic cause of liver disea se, In all cirrhotics both right and left atrial and right ventricle d iameters were significantly greater. Ejection fraction was slightly bu t significantly (P < .01) reduced in ascitic patients. Paracentesis in duced a reduction of the highly increased basal plasma renin activity, aldosterone, norepinephrine (P < .01), and epinephrine (P < .05) and improved diastolic function (E/A, P < .05), Systolic function was unaf fected, Thus, irrespective of ascites and cause, advanced cirrhosis is associated with left ventricle diastolic dysfunction and wall thickne ss increase. We can speculate that neurohumoral overactivity, known to stimulate cardiac tissue growth, may challenge the heart, promoting f ibrosis and exerting a further hindrance to ventricular relaxation in patients with cirrhosis experiencing episodes of ascites.