Cardiac dysfunction related to cirrhosis

LETTER TO THE EDITOR

Cardiac dysfunction related to cirrhosis

Odilson Marcos Silvestre^I; Alberto Queiroz Farias^II; Fernando Bacal^I

^IInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^IIHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil

^{Mailing Address}

Keywords: Heart Diseases / complications; Heart Disease / physiopathology; Liver Cirrhosis / complications; Liver Cirrhosis / physiopathology; Echocardiography.

Dear Editor,

A systematic review of Mota and Markman Filho¹ demonstrates that Doppler echocardiography is indicated in cases of cirrhosis, for investigation of pulmonary and vascular complications of cirrhotic cardiomyopathy. We agree that this test may show cardiac abnormalities related to cirrhosis. In our experience, 184 patients prospectively evaluated showed structural cardiac abnormalities at rest, which correlated with the severity of cirrhosis². However, the presence of these abnormalities is not sufficient to characterize cirrhotic cardiomyopathy. The criteria for diagnosis are not yet established or validated internationally. Clinical manifestations occur in conditions of stress. At rest, the heart is functionally normal. Hence, Doppler echocardiography at rest is often insufficient to characterize cirrhotic cardiomyopathy.

References

Manuscript received April 16, 2013; manuscript revised April 16, 2013; accepted May 10, 2013.

Reply

We are thankful to the statements of Silvestre et al¹, with which we agree and have mentioned in the introduction to our manuscript. Recent reviews^2,3 that address this issue describe a number of abnormalities on Doppler echocardiography at rest, characterizing cirrhotic cardiomyopathy: E/A ratio < 1; E wave deceleration time > 200 ms, isovolumic relaxation time > 80ms, increased left atrial volume, decreased left ventricular contractility, presence of wall hypokinesia and/or akinesia, increased myocardial mass, lowered ejection fraction (< 55%), among others.

Sincerely,

Vitor Gomes Mota

Brivaldo Markman Filho

References

Correspondência:

Odilson Marcos Silvestre

Rua Oscar Freire, 1.967, apto. 10B, Pinheiros

CEP 05409-011, São Paulo - SP - Brasil

E-mail: [e-mail], [e-mail]

Artigo recebido em 16/04/13; revisado em 16/04/13; aceito em 10/05/13.

Carta-resposta

Agradecemos as colocações de Silvestre e cols.¹, com as quais concordamos, fato este já citado na introdução do nosso artigo. Revisões recentes^2,3 que abordam o tema descrevem uma série de anormalidades ao ecodopplercardiograma de repouso, caracterizando a cardiomiopatia cirrótica: relação E/A < 1, : tempo de desaceleração da onda E > 200 ms, tempo de relaxamento isovolumétrico > 80ms, aumento do volume atrial esquerdo, diminuição da contratilidade do ventrículo esquerdo, presença de hipocinesia e/ou acinesia de parede, aumento da massa miocárdica, fração de ejeção rebaixada (< 55%), entre outras.

Atenciosamente,

Vitor Gomes Mota

Brivaldo Markman Filho

Referências

• 1. Mota VG, Markman Filho B. Echocardiography in chronic liver disease: systematic review. Arq Bras Cardiol. 2013 Mar 22. [Epub ahead of print]
• 2. Silvestre OM, Bacal F, de Souza Ramos D, Andrade JL, Furtado M, Pugliese V, et al. Impact of the severity of end-stage liver disease in cardiac structure and function. Ann Hepatol. 2013;12(1):85-91.
• 1. Mota VG, Markman Filho B. O ecoDopplercardiograma na doença hepática crônica: revisão sistemática. Arq Bras Cardiol. 2013 Mar 22. [Epub ahead of print]
• 2. Zardi EM, Abatte A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW, et al. Cirrhotic cardiomyopathy. J Am Coll Cardiol. 2010;56(7):539-49.
• 3. Moller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53(1):179-90.

Publication Dates

• Publication in this collection
  09 Sept 2013
• Date of issue
  Aug 2013