142 LEFT VENTRICLE ENLARGEMENT AND HIGHER SYSTOLIC VELOCITY IN MITRAL VALVE ARE INDIRECT MARKERS OF HEPATOPULMONARY SYNDROME

Results: LVDD was observed in 50% of patients (25% grade-1, 25% grade-2).Patients with LVDD had significant more severe liver failure, cardio-circulatory dysfunction and higher plasma levels of neurohumoral systems than those without LVDD.Patients with LVDD grade-2 had more severely impaired E (6.7±1.3 vs 7.8±0.6,p = 0.002) and markedly increased the ratio E/E' (12.5±2.6 vs 7.8±0.8,p < 0.001) than patients with LVDD grade-1.Patients with LVDD grade-2 compared with those with grade-1 showed higher MELD (20±5 vs 16±6 p < 0.05) and more intense cardio-circulatory dysfunction (arterial pressure: 73±10 vs 85±8 mmHg, p < 0.001; cardiac output: 5.4±1.0 vs 6.5±1.5L/min,p = 0.01; EF: 69±7 vs 74±8, p < 0.05; pulmonary capillary pressure:12±5 vs 7±3 mmHg; p = 0.001) and higher plasma levels of brain natriuretic peptide (144±71 vs 48±22 pg/ml, p < 0.001).Seventeen patients died during the 12-month transplant-free follow-up period.Mortality was higher in patients with LVDD grade-2 compared to LVDD grade-1 (67% vs 33%, p < 0.05).Independent predictive factors of mortality were MELD and LVDD grade-2.Conclusions: Cirrhotic cardiomyopathy occurs in the setting of a severe liver failure characterized by LVDD which play a role in the low systolic ventricular function.This could account for the greater severity of circulatory dysfunction and worse prognosis in patients with cirrhosis and LVDD grade-2.