Association of echocardiography-related parameters with the prognosis of decompensated cirrhosis: a retrospective cohort study

Abstract

Background

Cardiac morphology and function, which are conventionally evaluated by echocardiography, are often abnormal in decompensated cirrhosis. We aimed to evaluate the association of echocardiography-related parameters with prognosis in cirrhosis.

Methods

This retrospective study included 104 decompensated cirrhotic patients, in whom cardiac structure and function were measured by echocardiography, including mitral inflow early diastolic velocity/mitral inflow late diastolic velocity (E/A), left atrium diameter, left ventricular end-diastolic dimension, interventricular septal thickness, left ventricular posterior wall thickness, right atrial transverse diameter, right atrial longitudinal diameter, right ventricular dimension (RVD), stroke volume, cardiac output, left ventricular ejection fraction, and fractional shortening. Cox regression and competing risk analyses and Kaplan-Meier and Nelson-Aalen cumulative risk curves were used to evaluate their associations with further decompensation and death in cirrhotic patients, if appropriate.

Results

Lower RVD was a predictor of further decompensation in Cox regression (adjusted by Child-Pugh score: p = 0.138; adjusted by MELD score: p = 0.034) and competing risk analyses (p = 0.003), and RVD ≤17 mm was significantly associated with higher cumulative incidence of further decompensation in Kaplan-Meier (p = 0.002) and Nelson-Aalen cumulative risk curves (p = 0.002). E/A ≤ 0.8 was a significant predictor of death in Cox regression (adjusted by Child-Pugh score: p = 0.041; adjusted by MELD score: p = 0.045) and competing risk analyses (p = 0.024), and E/A ≤ 0.8 was significantly associated with higher cumulative incidence of death in Kaplan-Meier (p = 0.023) and Nelson-Aalen cumulative risk curves (p = 0.024). Other echocardiography-related parameters were not significantly associated with further decompensation or death.

Conclusion

RVD and E/A may be considered for the prognostic assessment of decompensated cirrhosis.

Keywords:

• Liver cirrhosis
• cirrhotic cardiomyopathy
• echocardiography
• further decompensation
• prognosis

Transparency

Declaration of funding

The study was partially supported by the Outstanding Youth Foundation of Liaoning Province (no. 2022-YQ-07).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization: Xingshun Qi; Formal analysis: Weiwei Wang, Yue Yin, Menghua Zhu, Hongxin Chen, Min Ding, and Xingshun Qi; Data curation: Weiwei Wang, Liyan Dong, Chunru Gu, Zhe Li, and Xingshun Qi; Writing–original draft: Weiwei Wang and Xingshun Qi; Writing–review and editing: Weiwei Wang, Liyan Dong, Yue Gao, Fangbo Gao, Zhongchao Wang, and Xingshun Qi; Supervision: Hongyu Li and Xingshun Qi. All authors have made an intellectual contribution to the manuscript and approved the submission.

Acknowledgements

The authors thank the participants of the study, including Yue Yin, Chunru Gu, Liyan Dong, Zhe Li, and Xiaohui Fang of our study team, for their efforts in setting up and updating our single-centre prospectively established database.

 Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethical approval

Approval of the research protocol: This study was conducted according to the principles of the Declaration of Helsinki and approved by the Medical Ethical Committee of the General Hospital of Northern Theatre Command [Y (2022) 201].