Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria. Alterations in ultrasonographic parameters of both left and right ventricles before and after stress

Background Prevalence of cirrhotic cardiomyopathy (CC) remains controversial. Several guidelines have been proposed for its assessment. Aim To estimate the frequency of CC by using all of the proposed diagnostic criteria, to describe the whole spectrum of cardiac alterations and investigate the role of stress in unmasking latent cases of CC. Methods Ninety consecutive patients were recruited. CC was evaluated by using the Montreal, the 2009 and 2019 criteria. Dobutamine stress test was also performed. Results LVDD was identified in 72(80%), 36(40%) and 10(11.1%) patients based on the above criteria, respectively. None of the patients had right ventricular systolic dysfunction, neither at rest, nor after stress. Stress test revealed left systolic dysfunction in 4(4.5%) patients. According to 2019 criteria, presence of LVDD was not associated with gender, etiology, or staging of liver disease. Patients with LVDD had longer QTc (p=0.002), larger LAvol (p=0.0001), lower TAPSE(s) (p=0.012), lower SRV(s) (p=0.0001) and lower ΔCI (p=0.009) compared to those without. Patients with Child-B/C had longer QTc (p=0.004), higher BNP (p=0.016), higher E/e’ (p=0.0001) and higher E/e’(s) (p=0.003), compared to Child-A patients. A significant correlation was demonstrated between Child-Pugh score and E/e’ (p=0.0001), or E/e’(s) (p=0.002). Conclusions In accordance with the recent guidelines the prevalence of CC seems to be lower. LVDD is the predominant feature of CC and aggravates along with the severity of liver disease. After dobutamine administration several sonographic variables exacerbate, particularly in Child-B/C patients, indicating a potential higher risk for clinical heart failure during stressful invasive interventions. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Ethics Committee of General Hospital of Athens "Laiko", Greece. A written consent was obtained from each patient with respect to all ethical guidelines issued by the 2000 revision (Edinburgh) of the 1975 Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). 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Yes All data produced in the present work are contained in the manuscript * CC : cirrhotic cardiomyopathy EF : ejection fraction TIPS : transjugular intrahepatic portosystemic shunt LVDD : left ventricular diastolic dysfunction 2D-SWE : two-dimension shear wave elastography ECG : electrocardiograph QTc : corrected QTc PW : pulsed wave TDI : tissue doppler imaging HR : heart rate LVEDD : left ventricular end diastolic diameter LVESD : left ventricular end systolic diameter LA vol : left atrium volume EF : ejection fraction at rest CI : cardiac index SVRI : systemic vascular resistance index E : peak early filling velocity during early ventricle diastole A : late diastolic filling velocity during atrial systole DT : deceleration time of E wave IVRT : isovolumetric relaxation time e’septal : early diastolic mitral annular velocity from the septal side e’lateral : early diastolic mitral annular velocity from the lateral side e’av : average early diastolic mitral annular velocity PASP : pulmonary artery systolic pressure TRV : tricuspid regurgitation velocity TAPSE : tricuspid annular plane systolic excursion SRV : systolic right ventricular function CI(s) : CI after stress e’septal(s) : early diastolic mitral annular velocity from the septal side after stress e’lateral(s) : early diastolic mitral annular velocity from the lateral side after stress TAPSE(s) : TAPSE after stress SRV(s) : SRV after stress TRV(s) : TRV after stress BNP : brain natriuretic peptide RVSD : right ventricular systolic dysfunction NPV : negative predictive value.