Modification of cardiac function in cirrhotic patients with and without ascites

OBJECTIVES: Abnormalities in cardiac function have been reported in liver c irrhosis, suggesting a latent cardiomyopathy in these patients. In this stu dy we investigated cardiac function in cirrhotic patients and in controls. METHODS: A total of 20 cirrhotic patients without previous or ongoing ascit es, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy c ontrols were studied by two-dimensional Doppler echocardiography. Cardiac d imensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according: to Ganau's criteria . Diastolic function was evaluated by the peak filling velocity of E wave a nd A wave, E/A ratio, and deceleration time of E wave. The pulmonary systol ic arterial pressure was also estimated in patients with tricuspid: insuffi ciency. RESULTS: Right and left atrium and right ventricle diameters were significa ntly enlarged in cirrhotic patients versus controls. E/A ratio was decrease d (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without as cites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systo lic arterial pressure was slightly elevated in patients with ascites (35 +/ - 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patient s) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05. The pattern of left ventricular geometry was normal in the majority of patients . Nitrite and nitrate levels were increased in cirrhotics irrespective of t he presence of ascites. CONCLUSIONS: Liver cirrhosis is associated with enlarged right cardiac cham bers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites., These changes do not depend on variations in the left ventricular geometry. (C) 2000 by Am. Cell. of Gastroenterolog y.