Liver cirrhosis linked to coronary abnormalities

Last Updated: 2015-04-22

By Larry Hand

NEW YORK (Reuters Health) - Physicians evaluating patients with severe cirrhosis of the liver for potential liver transplant should include an evaluation of the patient's heart, German researchers recommend.

In an autopsy study of almost 900 individuals who died with liver cirrhosis, the researchers found a high rate of right-ventricular abnormalities and coronary sclerosis.

"This postmortem study provides evidence of several cardiac changes, mainly of the right heart chamber, in cirrhotics. This should prompt physicians to evaluate the heart carefully in patients with liver cirrhosis, especially during transplant evaluation," senior author Dr. Stefan Luth, of the University Medical Center Hamburg-Eppendorf, Hamburg, told Reuters Health by email.

"So far, liver cirrhosis is a potential cause of malfunction of many organs, such as brain, kidney, gut, (and) lung, but the heart is not an established organ involved in severe liver dysfunction," Dr. Luth continued. "Interesting pathophysiological hypotheses have been published that have coined the term cirrhotic cardiomyopathy."

Although diagnostic criteria were established in 2010 for cirrhotic cardiomyopathy (http://bit.ly/1biz9Jl), the frequency and location of structural heart abnormalities have remained largely unknown, the researchers write in an article online April 6 in the Journal of Clinical Gastroenterology.

Dr. Luth and colleagues identified liver cirrhosis as a diagnosis in 895 of more than 19,000 autopsy reports at the University Medical Center Hamburg-Eppendorf between 1995 and 2010. They included 659 individuals with cirrhosis and 40 age- and sex-matched individuals without cirrhosis in their final analysis.

They assigned the cirrhosis group to subgroups based on etiology of disease: alcoholic cirrhosis (57.4%), cirrhosis due to nonalcoholic steatohepatitis (4.2%), viral hepatitis (9.3%), and cryptogenous cirrhosis (29.1%) for people not meeting any of the other three criteria.

They found that individuals with cirrhosis of any origin more often had a critical heart weight higher than controls (25% versus 10%, p=0.024). Mean heart weight came to 436 g for individuals with cirrhosis overall, compared to a mean heart weight of 386 g for controls.

Individuals in the nonalcoholic steatohepatitis group had the highest mean heart weight at 643 g, and individuals in the viral hepatitis group had the lowest at 381 g.

Individuals with cirrhosis of any origin also showed more right-ventricular hypertrophy (24% versus 3%, p<0.001), right-ventricular dilatation (36% versus 20%, p=0.040), and high-grade coronary sclerosis (30% versus 13%, p=0.019).

People in the nonalcoholic subgroup had higher rates of right- and left-ventricular hypertrophy and had greater odds for dilatation of any cardiac cavity and for having medium- or high-grade coronary sclerosis. Individuals in the alcohol group showed greater odds of right-ventricular hypertrophy and had an increased risk for high-grade coronary sclerosis, compared with controls.

The viral hepatitis group did not show any associations for increased abnormalities compared with controls, while the cryptogenic group had higher odds for multiple abnormalities.

Using multivariate logistic regression analysis, the researchers found that patient age independently predicted all cardiac pathologies except hypertrophy and epicardiac liposis, and male sex showed elevated odds for multiple abnormalities.

Overall, risk of cardiac death did not differ significantly between cirrhosis individuals and controls. However, individuals in the nonalcoholic group showed significantly greater risk of cardiac death (odds ratio 3.7, p=0.027).

The researchers concluded, "Cirrhotic patients should receive a profound cardiological evaluation before liver transplantation or transjugular intrahepatic portosystemic shunt."

Dr. Luth added, "We have looked at what changes happen in hearts of patients who died with liver cirrhosis, so this is an autopsy study that should lead to further investigations in patients with liver cirrhosis to prove our findings."

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1DMXh0z

J Clin Gastroenterol 2015.