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42. Echocardiographic Alterations in Liver Cirrhosis

Keenjhar Rani1, Zaman Baloch2, Ramesh Kumar2 and Kavita Bai2

ABSTRACT

Objective: To determine echocardiographic alterations in patients of liver cirrhosis.

Study Design: Cross-sectional descriptive study

Place and Duration of Study: This study was conducted at the Indus medical college and hospital, Tando Muhammad Khan from 11 October, 2019 to 11 March, 2020.

Materials and Methods: Study participants were the already diagnosed cases of liver cirrhosis. Liver cirrhosis been identified on the grounds of clinical history, systemic examination, laboratory investigations as well as ultrasonographic changes. On the basis of ultrasound findings, ascites graded clinically, conferring to ‘The International Ascites Club grading system’; Ascites considered as Grade I, when there was mild ascites noticeable by ultrasound only; Grade II, when there was moderate ascites and modest symmetrical distention of abdomen; Grade III, when there was gross ascites and also noticeable distention of abdomen.  Severity   of   illness graded by Child Pugh Scoring system. All study participants screened for both hepatitis C & B with thorough history and then undertook two dimensional transthoracic echocardiography with color Doppler. The cardiac variables measured by echo cardiography were left atrial diameter, left ventricular systolic and diastolic diameters, left ventricular posterior wall, right ventricular diameter, intervenetricular septum and ejection fraction.  Sampling technique was non probability purposive. Diagnosed patients of liver cirrhosisaged > 18 years and <75 years of any gender, included in this study. Confounding factors like previous heart disease (valvular heart disease, coro­nary heart disease, hypertension, congestive heart failure); chronic respiratory disease; chronic kidney disease; anemia; thyroid disease; hyperlipidemia or diabetes mellitus; previous GI bleeding wiin last 4 weeks excluded from this study.

Results: The liver cirrhosis patients with mean age of 48.52 years±8.1participated in the study.  Out of total 79, 58 and 21 were males and females respectively, while  63 found having hepatitis B and 16 with hepatitis C. According to Child Pugh scoring based disease severity, patients separated in three sets, i.e., A, B and C. Regarding echocardiographic alterations, means±sd of LVIDD.Ed, LVIDD.Es, left atrium, interventricular septum, aortic root and posterior wall among study population were 50.72cm ±8.42, 41.03±11.63, 35.45±4.8, 9.08±2.13, 25.41±3.92 and 9.17±1.66 respectively. While, ejection fraction (Ef) revealed as 30.46%±8.61& the E/A ratio of 1.07. Out of total 79, 37 (46%) identified as the cirrhotic cardiomyopathy. Echocardiographic alterations were statistically significant(p <0.05) in cirrhotic patients related with Child-Pugh scoring based disease severity.

Conclusion: This study revealed significant echocardiographic alterations in patients of liver cirrhosis.  That’s why, liver disease patients should be investigated by mean of echocardiography to avert under diagnosis of liver disease related cardiomyopathy for better prognosis.

Key Words: Liver cirrhosis, Child Pugh Scoring, cardiomyopathy, Echocardiographic

Citation of article: Rani K, Baloch Z, Kumar R, Bai K. Echocardiographic Alterations in Liver Cirrhosis. Med Forum 2021;32(3):172-176.