Dobutamine stress echocardiography for evaluating cirrhotic cardiomyopathy in liver cirrhosis
2
조회
0
다운로드
0
인용
0
참고문헌
초록
Background/Aims: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE). Methods: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured. Results: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed. Conclusions: Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
Abstract
Background/Aims: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE). Methods: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured. Results: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed. Conclusions: Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
참고문헌 (24)
- Howell WL, "The low incidence of myocardial infarction in patients with portal cirrhosis of the liver: A review of 639 cases of cirrhosis of the liver from 17,731 autopsies", Am Heart J, 60, pp.341~344 (1960)
- Melato M, "Stroke-cirrhosis relationship: an autopsy study in a heavy drinking population", Ital J Gastroenterol, 23, pp.211~214 (1991)
- Kowalski HJ, "The cardiac output at rest in Laennec's cirrhosis", J Clin Invest, 32, pp.1025~1033 (1953)
- Abelmann W, "The hemodynamic response to exercise in patients with Laennec's cirrhosis", J Clin Invest, 34, pp.690~695 (1955)
- Kim MY, "Cirrhotic cardiomyopathy", Korean J Hepatology, 13, pp.20~26 (2007)
- Baik SK, "Cirrhotic cardiomyopathy", Orphanet J Rare Dis, 2, pp.15~ (2007)
- Myers RP, "Cirrhotic cardiomyopathy and liver transplantation", Liver Transpl, 4(1), pp.S44~52 (2000)
- Baik SK, "Cirrhotic cardiomyopathy: causes and consequences", J Gastroenterol Hepatol, 19, pp.S185~S190 (2004)
- Lee SS, "Clinical consequences of liver disease: cardiovascular in akim and Boyer's HEPATOLOGY. Vol I. 5th ed.", pp.453~475 (2006), Saunders
- Coletta C, "Prognostic value of left ventricular volume response during dobutamine stress echocardiography", Eur Heart J, 18, pp.1599~1605 (1997)
- Azarbal B, "The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality: superiority over 85% of maximal age-predicted heart rate", J Am Coll Cardiol, 44, pp.423~430 (2004)
- Lauer MS, "stress testing as a predictor of mortality", JAMA, 281, pp.524~529 (1999)
- Jaue DN, "Cardiac muscarinic receptor function in rats with cirrhotic cardiomyopathy", Hepatology, 25, pp.1361~1365 (1997)
- Therapondos G, "Cardiac morbidity and mortality related to orthotopic liver transplantation", Liver Transpl, 10, pp.1441~1453 (2004)
- Wong F, "The cardiac response to exercise in cirrhosis", Gut, 49, pp.268~275 (2001)
- Cazzaniga M, "Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt", Gut, 56, pp.869~875 (2007)
- Valeriano V, "Modification of cardiac function in cirrhotic patients with and without ascites", Am J Gastroenterol, 95, pp.3200~3205 (2000)
- Finucci G, "Left ventricular diastolic function in liver cirrhosis", Scand J Gastroenterol, 31, pp.279~284 (1996)
- Pozzi M, "Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites", Hepatology, 26, pp.1131~1137 (1997)
- Wong F, "Role of cardiac structural and functional abnormalities in the pathogenesis of hyperdynamic circulation and renal sodium retention in cirrhosis", Clin Sci, 97, pp.259~267 (1999)
- Gaskari SA, "Therapy insight: Cirrhotic cardiomyopathy", Nat Clin Pract Gastroenterol Hepatol, 3, pp.329~337 (2006)
- Grose RD, "Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis", J Hepatol, 22, pp.326~332 (1995)
- Donovan CL, "Two-dimensional and dobutamine stress echocardiography in the preoperative assessment of patients with end-stage liver disease prior to orthotopic liver transplantation", Transplantation, 61, pp.1180~1188 (1996)
- Tsutsui JM, "Value of dobutamine stress myocardial contrast perfusion echocardiography in patients with advanced liver disease", Liver Transpl, 12, pp.592~599 (2006)