Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4779-4795
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4779
Liver cirrhosis and left ventricle diastolic dysfunction: Systematic review
Ieva Stundiene, Julija Sarnelyte, Ausma Norkute, Sigita Aidietiene, Valentina Liakina, Laura Masalaite, Jonas Valantinas
Ieva Stundiene, Julija Sarnelyte, Valentina Liakina, Laura Masalaite, Jonas Valantinas, Vilnius University, Institute of Clinical Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, Vilnius LT-03101, Lithuania
Ausma Norkute, Vilnius University, Institute of Clinical Medicine, Clinic of Internal diseases, Family medicine and Oncology, Vilnius University, Vilnius LT-03101, Lithuania
Sigita Aidietiene, Vilnius University, Institute of Clinical Medicine, Clinic of Cardiology and Angiology, Vilnius University, Vilnius LT-03101, Lithuania
Valentina Liakina, Vilnius Gediminas Technical University, Faculty of Fundamental Sciences, Department of Chemistry and Bioengineering, Vilnius LT-10223, Lithuania
Author contributions: Stundiene I, Sarnelyte J and Norkute A separately reviewed all of the titles, abstracts, full articles and performed data extraction. Aidietiene S and Masalaite L excluded irrelevant articles. Liakina V reviewed extracted data for accuracy. Stundiene I and Sarnelyte J wrote the manuscript with support from Norkute A. Valantinas J, Liakina V and Aidietiene S reviewed and approved the final submitted manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Julija Sarnelyte, MD, Academic Fellow, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Universiteto Street 3, Vilnius LT-03101, Lithuania. sarnelyte.julija@gmail.com
Telephone: +370-62602666
Received: April 22, 2019
Peer-review started: April 22, 2019
First decision: May 9, 2019
Revised: June 10, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019
Abstract
BACKGROUND

Liver cirrhosis is a chronic hepatic disease which is associated with cardiovascular abnormalities. Hyperdynamic circulation in liver cirrhosis causes functional and structural cardiac alterations. The prevalence of left ventricle diastolic dysfunction (LVDD) in cirrhotic patients ranges from 25.7% to as high as 81.4% as reported in different studies. In several studies the severity of diastolic dysfunction (DD) correlated with a degree of liver failure and the rate of dysfunction was higher in patients with decompensated cirrhosis compared with compensated. Future directions of comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients.

AIM

To clarify the correlation between the severity of liver cirrhosis and left ventricle diastolic dysfunction in the existing literature.

METHODS

Through January and February of 2019 at Vilnius University we conducted a systematic review of the global existing literature on the prevalence of left ventricle diastolic dysfunction in patients with liver cirrhosis. We searched for articles in PubMed, Medline and Web of science databases. Articles were selected by using adequate inclusion and exclusion criteria. Our interest was the outcome of likely correlation between the severity of cirrhosis [evaluated by Child-Pugh classes, Model For End-Stage Liver Disease (MELD) scores] and left ventricle diastolic dysfunction [classified according to American Society of Echocardiography (ASE) guidelines (2009, 2016)], as well as relative risk of dysfunction in cirrhotic patients. Subgroup analyses were performed to evaluate the ratio and grades of left ventricle diastolic dysfunction with respect to cirrhosis severity.

RESULTS

A total of 1149 articles and abstracts met the initial search criteria. Sixteen articles which met the predefined eligibility criteria were included in the final analysis. Overall, 1067 patients (out of them 723 men) with liver cirrhosis were evaluated for left ventricle diastolic dysfunction. In our systemic analysis we have found that 51.2% of cirrhotic patients had left ventricle diastolic dysfunction diagnosed and the grade 1 was the most prevalent (59.2%, P < 0.001) among them, the grade 3 had been rarely diagnosed - only 5.1%. The data about the prevalence of diastolic dysfunction in cirrhotic patients depending on Child-Pugh Classes was available from 5 studies (365 patients overall) and only in 1 research diastolic dysfunction was found being associated with severity of liver cirrhosis (P < 0.005). We established that diastolic dysfunction was diagnosed in 44.6% of Child-Pugh A class patients, in 62% of Child B class and in 63.3% of Child C patients (P = 0.028). The proportion of patients with higher diastolic dysfunction grades increases in more severe cirrhosis presentation (P < 0.001). There was no difference between mean MELD scores in patients with and without diastolic dysfunction and in different diastolic dysfunction groups. In all studies diastolic dysfunction was more frequent in patients with ascites.

CONCLUSION

This systemic analysis suggests that left ventricle diastolic dysfunction is an attribute of liver cirrhosis which has not received sufficient attention from clinicians so far. Future suggestions of a comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis for these patients and give hint for better understanding of the left ventricle diastolic dysfunction pathogenesis in liver cirrhosis.

Keywords: Liver cirrhosis, Left ventricle, Diastolic dysfunction, Correlation, Echocardiography, Systematic review

Core tip: In this systematic review we aimed to assess the association between left ventricle diastolic dysfunction and the severity of liver cirrhosis, evaluated by Child-Pugh classes. The proportion of patients with higher diastolic dysfunction grades increases in more severe cirrhosis presentation (P < 0.001). These results suggest that left ventricle diastolic dysfunction and its severity is an attribute of liver cirrhosis. Future directions of a comprehensive assessment of cardiac function in cirrhotic patients might provide a better prognosis to these patients and give hint for better understanding of the left ventricle diastolic dysfunction pathogenesis in liver cirrhosis.