Cirrhotic cardiomyopathy among patients with liver cirrhosis

Abstract

Introduction: Cirrhotic cardiomyopathy (CCM) is a clinical syndrome in patients with liver cirrhosis characterized by an abnormal and blunted response in cardiac output and contractility to physiologic, pathologic, or pharmacologic stress but a normal to increased cardiac response at rest [1-4]. Information on the epidemiology and natural history of CCM is limited. Methods: All patients with a diagnosis of cirrhosis (N = 451) seen at gastroenterology clinic over the four years were evaluated. CCM was defined using echocardiogram (ECHO) and electrocardiogram (ECG) criteria [1]. Patients with structural or ischemic heart disease or incomplete information were excluded (N = 220). Results: Among the 231 patients with cirrhosis, 118 (51.1%) met criteria for CCM, and no patient had this problem documented in their medical record. Those with CCM were older (62.7 vs 57.8 years; p < 0.001) and more likely to be female (55.8 vs 40.2%; p = 0.02) compared to those without CCM. The likelihood of CCM increased with each quartile of age (OR 1.6 per quartile; 95% CI 1 .2-2.0). Patients with alcoholic and unknown causes of cirrhosis are more likely to have CCM, (p < 0.001). CCM was more commonly associated with alcohol abuse in men than women (49.1 vs 21.3%; p = 0.002). Conclusion: CCM, a diagnosis of exclusion, defined by ECHO and ECG criteria is a common problem among cirrhotic patients attending a gastroenterology practice. Advancing age and female gender were associated with a higher prevalence of CCM, but the cause of cirrhosis was not possibly limited by smaller sample size within cause-specific categories. CCM was not recognized by our clinicians, and routine screening tests were not performed. Provider awareness of CCM is needed since implementation of angiotensin receptor blocker and beta-blocker therapy early in the course of cirrhosis may modify the changes in cardiac function [5,6].