Skip to main content
Springer Nature Link
Log in

Frequency and Severity of Cirrhotic Cardiomyopathy and Its Possible Relationship with Bacterial Endotoxemia

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

See More

The cardiac dysfunction presented in cirrhotic patients is already known as cirrhotic cardiomyopathy. The pathogenesis of this entity is not fully understood.

Aims

The aim of this study was to evaluate the frequency and characteristics of cirrhotic cardiomyopathy and to investigate the possible role of bacterial endotoxemia on its aggravation.

Methods

Forty-five cirrhotics were studied by a tissue Doppler imaging echocardiography at rest and after stress. The diagnosis of left ventricular diastolic dysfunction was based on the latest guidelines of the American Society of Echocardiography, whereas its severity was defined by the E/e’av ratio. Endotoxemia was estimated by measuring the serum levels of lipopolysaccharide-binding protein (LBP) and cytokines.

Results

None of the patients had systolic dysfunction, but 17/45 (37.8 %) had a diastolic one. Patients with grade II diastolic dysfunction had significantly longer QTc (p = 0.049), larger left atrium volume (p = 0.013), higher Brain Natriuretic Peptide levels (p = 0.007) and higher LBP levels (p = 0.02), compared to those with normal cardiac function, without differences in the systemic hemodynamics and the cytokines’ levels. Moreover, the severity of diastolic dysfunction as reflected by the E/e’av. was significantly correlated with the LBP levels (p = 0.002). On the multivariate analysis, the LBP was independently associated with the presence of diastolic dysfunction.

Conclusions

Cirrhosis is commonly complicated by cardiac dysfunction. Patients with severe cirrhotic cardiomyopathy have higher LBP levels, which are significantly correlated with the degree of diastolic dysfunction. Our findings support a potential role of bacterial endotoxemia on the aggravation of cardiomyopathy in cirrhotic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+
from $39.99 /Month
  • Starting from 10 chapters or articles per month
  • Access and download chapters and articles from more than 300k books and 2,500 journals
  • Cancel anytime
View plans

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, books and news in related subjects, suggested using machine learning.

Abbreviations

LVDD:

Left ventricular diastolic dysfunction

ADH:

Anti-diuretic hormone

TNF-α:

Tumor necrosis factor α

IL-6:

Interleukin 6

L-1β:

Interleukin 1β

NO:

Nitric oxide

CC:

Cirrhotic cardiomyopathy

SBP:

Spontaneous bacterial peritonitis

LBP:

Lipopolysaccharide-binding protein

BNP:

Brain natriuretic peptide

ECG:

Electrocardiograph

QTc:

Corrected QT interval

PW:

Pulse wave

TDI:

Tissue Doppler imaging

HR:

Heart rate

MAP:

Mean arterial pressure

LVEDD:

Left ventricular end diastolic diameter

LVESD:

Left ventricular end systolic diameter

LAvol in:

Left atrium volume index

LVEF%:

Left ventricular ejection fraction %

CI:

Cardiac index

SVRI:

Systemic vascular resistance index

DT:

Deceleration time

IVRT:

Isovolumetric relaxation time

PASP:

Pulmonary artery systolic pressure

MELD:

Model of end-stage liver disease

HRS:

Hepatorenal syndrome

References

  1. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rode’s J. Peripheral artery vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;5:1151–1157.

    Article  Google Scholar 

  2. Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology. 2006;43:S121–S131.

    Article  PubMed  CAS  Google Scholar 

  3. Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology. 2005;41:422–433.

    Article  PubMed  CAS  Google Scholar 

  4. Bellot P, Garcia-Pagan JC, France’s R, et al. Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis. Hepatology. 2010;5:2044–2052.

    Article  Google Scholar 

  5. Vlachogiannakos J, Saveriadis AS, Viazis N, et al. Intestinal decontamination improves liver haemodynamics in patients with alcohol-related decompensated cirrhosis. Aliment Pharmacol Ther. 2009;29:992–999.

    Article  PubMed  CAS  Google Scholar 

  6. Moller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53:179–190.

    Article  PubMed  Google Scholar 

  7. Alqahtani SA, Fouad TR, Lee SS. Cirrhotic cardiomyopathy. Semin Liver Dis. 2008;28:59–69.

    Article  PubMed  CAS  Google Scholar 

  8. Zambruni A, Trevisani F, Caraceni P, Bernardi M. Cardiac electrophysiological abnormalities in patients with cirrhosis. J Hepatol. 2006;44:994–1002.

    Article  PubMed  CAS  Google Scholar 

  9. Ma Z, Miyamoto A, Lee SS. Role of altered beta-adrenoceptor signal transduction in the pathogenesis of cirrhotic cardiomyopathy in rats. Gastroenterology. 1996;110:1191–1198.

    Article  PubMed  CAS  Google Scholar 

  10. Ma Z, Meddings JB, Lee SS. Membrane physical properties determine β-adrenergic receptor function in cirrhotic rats. Am J Physiol. 1994;267:G87–G93.

    PubMed  CAS  Google Scholar 

  11. Gaskari SA, Liu H, Moezi L, Li Y, Baik SK, Lee SS. Role of endocannabinoids in the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats. Br J Pharmacol. 2005;146:315–323.

    Article  PubMed  CAS  Google Scholar 

  12. Liu H, Ma Z, Lee SS. Contribution of nitric oxide to the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats. Gastroenterology. 2000;118:937–944.

    Article  PubMed  CAS  Google Scholar 

  13. Kleber G, Braillon A, Gaudin C, Champigneulle B, Cailmail S, Lebrec D. Hemodynamic effects of endotoxin and platelet activating factor in cirrhotic rats. Gastroenterology. 1992;103:282–288.

    PubMed  CAS  Google Scholar 

  14. Guilo P, Mansourati J, Maheu B, et al. Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence. Am J Cardiol. 1997;79:1276–1278.

    Article  Google Scholar 

  15. Perez-Paramo M, Munoj J, Albillos A, et al. Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites. Hepatology. 2000;31:43–48.

    Article  PubMed  CAS  Google Scholar 

  16. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–133.

    Article  PubMed  Google Scholar 

  17. Achecar L, Gonzalez-Tallon A, Mesonero F, Serradilla R, Milicua JM, Ruiz-del-Arbol L. Relationship between circulatory dysfunction and severity of cardiomyopathy in patients with cirrhosis. J Hepatol. 2011;54:S61–S62.

    Article  Google Scholar 

  18. Krag A, Bendtsen F, Henriksen JH, Moller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010;59:105–110.

    Article  PubMed  CAS  Google Scholar 

  19. Nazar A, Sitges M, Guevara M, et al. Cardiomyopathy in patients with cirrhosis. Frequency, characteristics and relationship with circulatory dysfunction and prognosis. J Hepatol. 2010;53:S85.

    Google Scholar 

  20. Bernardi M, Calandra S, Colantoni A, et al. Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology. 1998;27:28–34.

    Article  PubMed  CAS  Google Scholar 

  21. Henriksen JH, Goetze JP, Fuglsang S, Christensen E, Bendtsen F, Moller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut. 2003;52:1511–1517.

    Article  PubMed  CAS  Google Scholar 

  22. Albillos A, De La Hera A, Gonzalez M, et al. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement. Hepatology. 2003;37:208–217.

    Article  PubMed  CAS  Google Scholar 

  23. Rozenberg S, Besse S, Brisson H, et al. Endotoxin-induced myocardial dysfunction in senescent rats. Crit Care. 2006;10:R124.

    Article  PubMed  Google Scholar 

  24. Schumann RR, Latz E. Lipopolysaccharide-binding protein. Chem Immunol. 2000;74:42–60.

    Article  PubMed  CAS  Google Scholar 

  25. Opal SM, Scannon PJ, Vincent JL, et al. Relationship between plasma levels of lipopolysaccharide (LPS) and LPS-binding protein in patients with severe sepsis and septic shock. J Infect Dis. 1999;180:1584–1589.

    Article  PubMed  CAS  Google Scholar 

  26. Krag A, Bendtsen F, Kjaer A, Leth-Petersen C, Moller S. Cardiac function studied by dobutamine stress MRI in patients with mild cirrhosis. J Hepatol. 2009;50:S277.

    Article  Google Scholar 

  27. Klein AL, Burstow DJ, Talik AJ, Zachariak PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–224.

    Article  PubMed  CAS  Google Scholar 

  28. Wong F, Villamil A, Merli M, et al. Prevalence of diastolic dysfunction in cirrhosis, and its clinical significance. Hepatology. 2011;54:475A–476A.

    Article  Google Scholar 

  29. Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med. 1989;320:409–415.

    Article  PubMed  CAS  Google Scholar 

  30. Preedy VR, Siddiq T, Why H, Richardson PJ. The deleterious effects of alcohol on the heart: involvement of protein turnover. Alcohol Alcohol. 1994;29:141–147.

    PubMed  CAS  Google Scholar 

  31. Harcombe AA, Ramsay L, Kenna JG, et al. Circulation antibodies to cardiac protein-acetaldehyde adducts in alcoholic heart muscle disease. Clin Sci. 1995;88:262–268.

    Google Scholar 

  32. Pozzi M, Carugo S, Boari G, et al. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. Hepatology. 1997;26:1131–1137.

    PubMed  CAS  Google Scholar 

  33. Grose RD, Nolan J, Dillon JF, et al. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis. J Hepatol. 1995;22:326–332.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Hepatogastroenterology Unit, 1st Department of Medicine Propaedeutic, Medical School of Athens, Laikon General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece

    Dimitrios S. Karagiannakis, Jiannis Vlachogiannakos, Irini Vafiadis-Zouboulis & Spiros D. Ladas

  2. Department of Cardiology, Laikon General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece

    Georgios Anastasiadis

Authors
  1. Dimitrios S. Karagiannakis
    View author publications

    Search author on:PubMed Google Scholar

  2. Jiannis Vlachogiannakos
    View author publications

    Search author on:PubMed Google Scholar

  3. Georgios Anastasiadis
    View author publications

    Search author on:PubMed Google Scholar

  4. Irini Vafiadis-Zouboulis
    View author publications

    Search author on:PubMed Google Scholar

  5. Spiros D. Ladas
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios S. Karagiannakis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karagiannakis, D.S., Vlachogiannakos, J., Anastasiadis, G. et al. Frequency and Severity of Cirrhotic Cardiomyopathy and Its Possible Relationship with Bacterial Endotoxemia. Dig Dis Sci 58, 3029–3036 (2013). https://doi.org/10.1007/s10620-013-2693-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1007/s10620-013-2693-y

Keywords