The association of liver steatosis assessed by the controlled attenuated parameter and severity of liver disease with the presence of cirrhotic cardiomyopathy

Introduction Recently, new criteria for cirrhotic cardiomyopathy (CCM) by a multidisciplinary consortium were published (Izzy et al.Hepatology 2020;71:334-345). Systolic dysfunction of the left ventricle was defined as reduced ejection fraction (EF)≤50 % and/or absolute global longitudinal strain (GLS) less negative than -18 %, while diastolic dysfunction is diagnosed when three of the following conditions are present:E/e’ ratio >14,peak tricuspid regurgitation velocity >2.8 m/s,septal e’<7cm/s,left atrial volume index >34 ml/m².

Aim To assess the association between liver steatosis assessed by controlled attenuation parameter(CAP) and severity of liver disease with the presence of CCM defined according to the new diagnostic criteria.

Methods Consecutive cirrhotic patients without structural heart disease,no HCC outside Milan criteria,absence of TIPS,and optimal acoustic echocardiography window were included. Conventional and speckle-tracking echocardiography (Vendor GE,EchoPAC PC software) were performed by two EACVI TTE certified investigators. Liver steatosis (controlled attenuated parameter-CAP) and liver stiffness (LS) were assessed by transient elastography (TE,Fibroscan®,Echosens). Reliable results were defined as a median value of 10 valid measurements with an IQR/Med <30 %.

Results 122 of 371 cirrhotic patients fulfilled the inclusion criteria. The mean age was 56.8±11.8 years (62.5 % males),68.7 % had alcoholic etiology, and 59.3 % presented with compensated cirrhosis.Valid TE measurements were obtained in 96/122(78.6 %) cases and were included in the final analysis. LS and CAP measurement failures were mainly due to ascites. According to the new criteria, CCM was diagnosed in 15/96(15.6 %) of patients: systolic dysfunction in 11.4 %,diastolic dysfunction in 7.3 % of cases. Combined systolic and diastolic dysfunction was present in 3.1 % of cases. The presence of systolic dysfunction was associated with older age,higher body mass index,and liver steatosis evaluated by CAP (Table).

Conclusion According to the new criteria, around 15 % of cirrhotic patients were diagnosed with CCM. Age and CAP assessed by TE seem to correlate with reduced systolic left ventricular function.