THERAPEUTIC CHALLENGES AND PROGNOSIS INFLUENCE OF CARDIOVASCULAR COMORBIDITIES IN CIRRHOTIC PATIENTS

Authors

  • R.S. MIFTODE “Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • O. MITU Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • A. CRISAN “Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • Adriana ION “Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • Amalia DARIE “Sf. Spiridon” County Clinical Emergency Hospital Iasi
  • Larisa MIFTODE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • A.D. COSTACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina GÎRLEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina Iuliana COSTACHE “Sf. Spiridon” County Clinical Emergency Hospital Iasi

Abstract

The effects of advanced liver diseases on heart function, like cirrhotic cardiomyopathy, hepato-pulmonary syndrome or porto-pulmonary arterial hypertension, are well known today. Cardiovascular Diseases (CVD) may affect the liver or increase a pre-existed liver disease in acute or chronic heart failure. The aim of this study was to evaluate the frequency of CV comorbidities in cirrhotic patients and to establish the influence on patients’ outcome. Material and methods: The current prospective study was conducted over a 16-month period and included 105 patients diagnosed with liver cirrhosis (LC). Patients were extensively analyzed for the presence of CVD, both clinical and echo cardio graphic. Results: The main etiology of LC was viral C infection, followed by alcoholic exposure. Dilatative cardiomyopathy, high blood pressure, heart failure with reduced ejection fraction, arrhythmias and deep vein thrombosis were more prevalent in patients with viral liver disease.  The valvular diseases were more frequent diagnosed in patients with a worse prognosis (31.4% vs. 25.7%, p =0.001), though there were no difference between patients with viral or alcoholic etiology. Conclusions: Our study confirmed that there is a high prevalence of different CVD in patients with LC, mostly in patients with viral etiology, and there is a great need for standardized protocols and guidelines for the initial approach, treatment and follow-up of the CV dysfunction in LC patients.

Author Biographies

  • R.S. MIFTODE, “Sf. Spiridon” County Clinical Emergency Hospital Iasi

    Department of Cardiolog
    “Grigore T. Popa” University of Medicine and Pharmacy Iasi
    Faculty of Medicine
    Department of Medical Specialties (I)

  • O. MITU, Sf. Spiridon” County Clinical Emergency Hospital Iasi

    Department of Cardiolog
    “Grigore T. Popa” University of Medicine and Pharmacy Iasi
    Faculty of Medicine
    Department of Medical Specialties (I)

  • Amalia DARIE, “Sf. Spiridon” County Clinical Emergency Hospital Iasi

    Department of Cardiolog
    “Grigore T. Popa” University of Medicine and Pharmacy Iasi
    Faculty of Medicine
    Department of Medical Specialties (II)

  • Larisa MIFTODE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (II

  • A.D. COSTACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Medical Student

  • Irina GÎRLEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (I)

  • Irina Iuliana COSTACHE, “Sf. Spiridon” County Clinical Emergency Hospital Iasi

    Department of Cardiolog
    “Grigore T. Popa” University of Medicine and Pharmacy Iasi
    Faculty of Medicine
    Department of Medical Specialties (I)

References

1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. Journal of hepatology 2019; 70(1): 151-171.
2. Bansilal S, Castellano, JM, Fuster V. Global burden of CVD: focus on secondary prevention of cardi-ovascular disease. International journal of cardiology 2015; 201: S1-S7.
3. Lee SS, Baik SK. Cardiovascular Complications of Cirrhosis. In: Zakim and Boyer’s Hepatology; Elsevier, 2012, 369-393.
4. Crooks CJ, West J, Jepsen P. A validation study of the CirCom comorbidity score in an English cir-rhosis population using the Clinical Practice Research Datalink. Clinical epidemiology 2018; 10: 107.
5. Wang X, Lin SX, et al. Study of liver cirrhosis over ten consecutive years in Southern China. World journal of gastroenterology: WJG 2014; 20(37): 13546.
6. Sivanathan V, Kittner JM, et al. Etiology and complications of liver cirrhosis: data from a German center. Deutsche medizinische Wochenschrift (1946) 2014; 139(36): 1758-1762.
7. Wong, F. Management of ascites in cirrhosis. Journal of Gastroenterology and Hepatology 2012; 27(1): 11-20.
8. Wiese S, Hove JD, Bendtsen F, Møller S. Cirrhotic cardiomyopathy: pathogenesis and clinical rele-vance. Nature reviews Gastroenterology & hepatology 2014; 11(3): 177.
9. Barbosa MM, Freire CM, et al. Rest left ventricular function and contractile reserve by dobutamine stress echocardiography in peripartum cardiomyopathy. Revista Portuguesa de Cardiologia (English Edition) 2012; 31(4): 287-293.
10. Ilyas JA, O’Mahony CA, Vierling JM. Liver transplantation in autoimmune liver diseases. Best prac-tice & research Clinical gastroenterology 2011; 25(6): 765-782.
11. Poller WC, Pieber M, et al. Very small superparamagnetic iron oxide nanoparticles: Long-term fate and metabolic processing in atherosclerotic mice. Nanomedicine: Nanotechnology, Biology and Medicine 2018; 14(8): 2575-2586.
12. Aneni EC, Oni ET, et al. Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk. Journal of hypertension 2015; 33(6): 1207-1214.
13. Costache II, Miftode E, Ovidiu M, Aursulesei V. Sex differences in cardiovascular risk factors in a rural community from North Romania region. Revista de Cercetare și Intervenție Socială 2016; 55: 204-214.
14. Alqahtani SA, Stemer AB, et al. Endovascular management of stroke patients with large vessel occlu-sion and minor stroke symptoms. Cureus 2017; 9(6): e1355.
15. Raff EJ, Kakati D, Bloomer JR, Shoreibah M, Rasheed K, Singal AK. Diabetes mellitus predicts occurrence of cirrhosis and hepatocellular cancer in alcoholic liver and non-alcoholic fatty liver dis-eases. Journal of clinical and translational hepatology 2015; 3(1): 9-16.
16. Balbi M, Donadon, V, et al. Alcohol and HCV chronic infection are risk cofactors of type 2 diabetes mellitus for hepatocellular carcinoma in Italy. International journal of environmental research and public health 2010; 7(4): 1366-1378.
17. Jepsen P, Lash TL, Vilstrup H. The clinical course of alcoholic cirrhosis: development of comorbid diseases. A Danish nationwide cohort study. Liver International 2016; 36(11): 1696-1703.
18. Facciorusso A. The influence of diabetes in the pathogenesis and the clinical course of hepatocellular carcinoma: recent findings and new perspectives. Curr Diabetes Rev 2013; 9(5): 382-386.
19. Wlazlo N, van Greevenbroek MM, et al. Diabetes mellitus at the time of diagnosis of cirrhosis is associated with higher incidence of spontaneous bacterial peritonitis, but not with increased mortali-ty. Clinical science 2013; 125(7): 341-348.

Additional Files

Published

2020-06-30

Issue

Section

INTERNAL MEDICINE - PEDIATRICS