Functional and morphological myocardial changes in hepatitis C virus patients with end-stage liver disease

Abstract

Background and objectives. Cardiovascular complications are common in liver transplant recipient. This study aims to evaluate functional and morphological myocardial changes in hepatitis C virus (HCV) patients with end-stage liver disease (ESLD) by cardiac magnetic resonance (CMR). Methods. This cross-sectional study included 84 patients with HCV-related ESLD. They were subjected to 2D-echocardiography and CMR. The presence, distribution, and percentage of delayed myocardial enhancement (DME) were estimated. Results. The mean Model for End-Stage Liver Disease score was 21.5 ± 6.3. In CMR, all patients showed good global left ventricular (LV) systolic function (mean ejection fraction = 66.5 ± 8.6%; range: 55–80) with normal wall thickness and motion. Left ventricle was mildly dilated in 25 patients (30%). Grade I and grade II diastolic dysfunction was detected in 81 patients (96.4%) with dilated left atrium in 25 patients (30%). Variable degrees of DME were detected in 70 patients (83.3%) with mean percentage of DME (%DME) being 19.5 ± 16% (range: 4–52). A significant negative correlation was found between %DME and LV ejection fraction (r = -0.7; p < 0.001), cardiac output (r = -0.5; p = 0.013), cardiac index (r = -0.5; p = 0.02), and serum albumin level (r = -0.5; p = 0.01). The %DME ≥19% was associated with 85.7% sensitivity and 85.7% specificity for detection of LV ejection fraction <60% as assessed by echocardiography (area under curve = 0.89; p = 0.001). Conclusion. DME with CMR is a common finding among patients with HCV-related ESLD. The extent of DME is significantly associated with global LV systolic function.

Key Words:

• cardiomyopathies
• echocardiography
• end-stage liver disease
• magnetic resonance imaging

Acknowledgment

Dalia Omran conducted the study design aided by the co-authors. Dalia Omran and Mohamad Mahmoud managed the patients clinically and collected the clinical data. Noha Behairy performed all the MRI scans and Karim Said performed the 2D-echocardiography examinations. Khaled Serag Dalia Omran and Mohamad Mahmoud analyzed the data statistically and interpreted the results. All authors have contributed in writing the manuscript. Dalia Omran edited and submitted the manuscript.

Declaration of interest: All authors declare no financial, professional, or personal conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.