RecruitingACTRN12621000895886

Heart dysfunction in patients with liver cirrhosis

Evaluation for cirrhotic cardiomyopathy: A prospective study of global cardiac function in decompensated cirrhosis and its clinical significance

Sponsor

Flinders Medical Centre

Enrollment

80 participants

Start Date

Jan 13, 2021

Study Type

Observational

Conditions

hepatorenal syndrome

Summary

Cirrhotic cardiomyopathy (CCM) is a specific type of cardiac dysfunction seen in liver cirrhosis without a primary cardiac cause. It is an important cause of morbidity and mortality before and after liver transplantation (LT). Despite its high prevalence, it is relatively understudied as the diagnosis often becomes clearer only under stressful conditions. The study aims to define early diagnosis of cirrhotic cardiomyopathy using advanced echocardiographic techniques and its clinical significance. In addition, the reversibility of cardiac dysfunction thus studied, will be assessed after LT. In a cohort of 80 consecutive cirrhotic patients, this will evaluate global myocardial work index (GWI)and global longitudinal strain (GLS) as markers of CCM under resting conditions and under pharmacologically induced stress when necessary. The study cohort will be followed-up for 12 months with respect to development of complications such as renal dysfunction, fluid overload, cardiac failure and death/ Lliver transplantation. It will provide the first ever description of GWI and GLS in the diagnosis of CCM in decompensated cirrhosis and its clinical correlation.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Inclusion Criteria5

Consecutive consenting cirrhotic patients with ascites and or past history of ascites on diuretics including
a) those requiring abdominal paracentesis,
b) hydrothorax requiring thoracentesis,
c) planned for TIPS.
Consecutive cirrhotic patients undergoing LT assessment with or without ascites.

Exclusion Criteria8

ongoing sepsis on inotropes;
ongoing grade 2–4 hepatic encephalopathy;
known coronary artery disease;
other known cardiac diagnoses such as valvular heart disease, dilated, hypertrophic and restrictive cardiomyopathy
Uncontrolled systemic hypertension
Contraindications to dobutamine, including:
o Previous sensitivity to dobutamine
o Previous documented Ventricular Tachycardia or Ventricular Fibrillation

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Interventions

Each patient will have their blood tests for troponin and BNP added to their reguaklr blood tests. They will receive an appointment for Electrocardiogram, Transthoracic echocardiogram and dobutamine stress echocardiogram which will approximately take 40-50 minutes. This will be performed by a senior echocardiographer under the supervision of a cardiologist in the cardiology investigation suite. Patients will be followed up for the next 12 months using the elctronic medical records. Those who undergo liver transplantation will undergo a repeat echocardiogram 12 months after their trasnplantation