Packiaselvam, M (2020) A Study on Cardiac Dysfunction in Non Diabetic, Non Hypertensive patients with Liver Cirrhosis. Masters thesis, Tirunelveli Medical College, Tirunelveli.
|
Text
200100820packiaselvam.pdf Download (9MB) | Preview |
Abstract
INTRODUCTION: Cirrhosis and portal hypertension is associated with “hyperdynamic syndrome” which is characterised by increased cardiac output and heart rate and splanchnic vasodilatation and reduced systemic vascular resistance. Although there is a hyperdynamic circulation the ventricular response to sympathetic stimuli was found to be reduced in cirrhotic patients. Initially it was thought these changes were seen only in alcoholic patients with cirrhosis but later it was found that patients with non alcoholic cirrhosis also had similar cardiac functional abnormalities thus the term “cirrhotic cardiomyopathy” was introduced to describe these changes in cirrhotic patients. AIM OF THE STUDY: 1. To study the cardiac dysfunction in cases diagnosed with cirrhosis of liver in nonalcoholic patients with other causes of cirrhosis. 2. To study the relationship between the severity of cirrhosis and the presence of cirrhotic cardiomyopathy. MATERIALS AND METHODS: Patients included in the study were recruited from the Department of General Medicine at Tirunelveli Medical College Government Hospital during the period of 2017-2019. Inclusion Criteria: Non alcoholic patients diagnosed with cirrhosis of formed the study group. Exclusion Criteria: Cases with the following features were excluded from the study: • Cases who are hypertensive. • Diabetic cases. • Alcoholic cases. • Cases with severe ascites. • Coronary artery disease and heart failure patients. • Cases with risk factors for cardiomyopathy other than cirrhosis. • Recent UGI bleed history bleed. • Cases with severe anemia. Investigations done include • Complete blood count, • Liver function test, • Ultrasound scan of the abdomen along with • Doppler scan, • Viral markers, • Ascitic fluid analysis, • Electrocardiography, and echocardiography. • Coagulation profile. The parameters assessed were in echocardiography are E/A ratio and ejection fraction. The diagnostic criteria included E/A ratio less than 1 in this study. and ejection fraction of 60% were considered mean of the normal values while doing statistical analysis. The statistical analysis was done using SSPS software version 15. Univariate and multivariate analysis were done with Chi Square test. P value of < 0.05 was observed to be significant. Percentage calculation was done whenever appropriate. Of the 100 cases included in this study 33 patients were below 40 years of age, 36 cases were between 40 and 50 years of age and 31 cases were above 50 years of age. RESULTS: The study we conducted shows 40 cases had cirrhosis because of HBV infection, 4 caused by HCV infection, 4 caused by primary biliary cirrhosis and in 52 cases the reason was idiopathic. Out of the 100 cases studies the characteristic featrues of cirrhotic cardiomyopathy were observed in 87 cases. The evidence of cirrhotic cardiomyopathy was seen in all etiologies and not just alcoholic cirrhosis. It has been shown in other studies that various etiologies of cirrhosis can lead to cirrhotic cardiomyopathy. It was also found in many studies that cardiac dysfunction in cirrhotics was independent of the cause of the cirrhosis. Our study has also prove that the incidence of cirrhotic cardiomyopathy was not dependent on the cause of cirrhosis. We took 100 cases for our study out of which 73 were females and 27 males. Among the 73 females 60 of them showed evidence of cirrhotic cardiomyopathy. It has been observed that out of the 27 males all of them had evidence of cirrhotic cardiomyopathy. Our study is confirming that there is negligible significance in sex distribution and that evidence of cirrhotic cardiomyopathy is observed in majority of the cirrhotics. In the study we conducted 33% (30 subjects)of the cases were below 40 years and 67% more than 40 years. The 13 patients who did not show features of cirrhotic cardiomyopathy were less than 40 years. This is statistically significant and signifies that the incidence of cirrhotic cardiomyopathy increase with age and is more commonly seen in older people. Ascites was present in 80% of the cases as one of the complaints during their first admission and it was also observed that all the cases who had ascites also showed the features of cirrhotic cardiomyopathy. 33% of the cases who did not have ascites had features of cirrhotic cardiomyopathy. It was observed that 92% of the patients with cirrhotic cardiomyopathy also had ascites ascites and in 8.00% there was no evidence of ascites. This in turn confirms that evidence of ascites and the incidence of cirrhotic cardiomyopathy has a very important correlation significantly (‘p’=0.0002). In the study we conducted 33% (30 subjects)of the cases were below 40 years and 67% more than 40 years. The 13 patients who did not show features of cirrhotic cardiomyopathy were less than 40 years. This is statistically significant and signifies that the incidence of cirrhotic cardiomyopathy increase with age and is more commonly seen in older people. Ascites was presnt in 80% of the cases as one of the complaints during their first admission and it was also observed that all the cases who had ascites also showed the features of cirrhotic cardiomyopathy. 33% of the cases who did not have ascites had features of cirrhotic cardiomyopathy. It was observed that 92% of the patients with cirrhotic cardiomyopathy also had ascites ascites and in 8.00% there was no evidence of ascites. This in turn confirms that evidence of ascites and the incidence of cirrhotic cardiomyopathy has a very important correlation significantly (‘p’=0.0002). The development of features of cirrhotic ccardiomyopathy can be an important contributor to the development of sodium and fluid retention leading to ascites since the figures also suggest that 92 % of cases with cirrhotic cardiomyopathy also have ascites. But in this study we found that ascites was present in majority of cases with diastolic dysfunction. Lee et al13 found that once cirrhosis has advanced to a moderate stage with the development of ascites some degree of diastolic dysfunction is always present. 67% of the cases were found to have CTP Class A cirrhosis. 33% of the cases presented with Class B cirrhosis. 80% of Class A had charactistic features of cirrhotic cardiomyopathy while all the cases with Class B showed features of cirrhotic cardiomyopathy. 61.5% of the cases with cirrhotic cardiomyopathy had Class A cirrhosis. 38.5% had Class B cirrhosis. 20% of Class A and 13.3% of Class B cirrhosis did not have features of cirrhotic cardiomyopathy. The severity of cirrhosis as based on CTP does not correlate with the presence of cirrhotic cardiomyopathy (‘p’= 0.336). 46.7% of the cases had end diastolic volume above 90. 85.7% of the cases with EDV above 90 had E/A ratio below 1. 87.5% of cases with EDV below 90 also had E/A ratio below 1. 46.2% of the cases with E/A ratio below 1 had EDV above 90. 53.8% of the cases with E/A ratio below 1 had EDV below 90. These findings indicate that end diastolic volume is not significant indicator of diastolic dysfunction (‘p’ = 0.885). 10% of the cases had end systolic volume above 38. 66.7% of the cases with ESV above 38 had E/A ratio below 1. 88.9% of the cases with ESV below 38 also had E/A ratio below 1. 7.7% of the cases with E/A ratio below 1 had ESV above 38. 25% of the cases with E/A ratio above 1 also had ESV above 38. These findings indicate that end systolic volume is not significant indicator of cardiac dysfunction (‘p’ = 0.282). 96.7% of the cases had ejection fraction above 60%. 86.2% of the cases with EF above 60 had E/A ratio below 1. 96.2% of the cases with E/A below 1 had EF above 60. All the cases that had E/A ratio above 1 also had EF above 60. These findings indicate that ejection fraction is not significant indicator of cardiac dysfunction (‘p’ = 0.689). CONCLUSION: Contrary to older perceptions patients with cirrhosis due to causes other than alcohol do present with features of cirrhotic cardiomyopathy. The most common manifestation is in the form of diastolic dysfunction which is shown to occur as E/A ratio less than 1. Cirrhotic cardiomyopathy occurs independent of the cause of cirrhosis. Mild to moderate degree of diastolic dysfunction is seen in majority of cirrhotic. The incidence of Diastolic dysfunction increases with age in cirrhosis and occurs more commonly in older population. Ascites has been observed in is all cases with diastolic dysfunction. The severity of cirrhosis is independent of the presence of diastolic dysfunction.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201711361 |
| Uncontrolled Keywords: | Cirrhosis, cardiac dysfunction, systolic function in cirrhosis, diastolic function in cirrhosis, non alcoholic cirrhosis. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Jan 2021 18:35 |
| Last Modified: | 29 Jan 2021 07:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13325 |
Actions (login required)
 |
View Item |
