Left Ventricular Myocardial Mechanics in Cirrhosis: A Speckle Tracking Echocardiographic Study

Cirrhosis is commonly associated with impaired left ventricular (LV) myocardial contractile reserve to stress and diastolic dysfunction. The aim of this study was to assess LV systolic performance at rest, using both standard echocardiographic indices and novel deformation-rotational parameters, in order to elucidate the pathophysiologic basis of cardiac dysfunction in cirrhosis. Seventy-seven men with cirrhosis (mean age 54.4 +/- 9.7) of variable Child-Pugh class (A, B, C) and 20 healthy control subjects were prospectively evaluated by standard as well as speckle tracking echocardiography. Left ventricular ejection fraction (LVEF) was significantly higher in patients with cirrhosis compared to controls (64.6 +/- 5.7% in controls vs. 71 +/- 9.5%, 71.2 +/- 7.1%, and 73 +/- 7% in Child-Pugh classes A, B, and C, respectively, P=0.002). Interestingly, LV systolic function augmentation was not associated with changes in LV longitudinal deformation (LV strain -19 +/- 1.9% in controls vs. -20.1 +/- 5.3% in class A vs. -21.3 +/- 2.6% in class B vs. -21 +/- 3.4% in class C, P=NS), but a statistically significant increase in LV apical systolic rotation and accordingly in LV twist was observed (LV twist 13.0 +/- 3 degrees in controls vs. 14.9 +/- 5 degrees in class A vs. 16.5 +/- 2.8 degrees in class B vs. 18.2 +/- 2.9 degrees in class C, P<0.0005). Despite the increase in LV rotation, time to both basal and apical peak systolic rotation was significantly delayed in patients compared to healthy controls (P=0.015 and P=0.017 accordingly). Increased EF in cirrhosis could be attributed to increased LV torsion. Despite the improved rotation values at rest, there is a significant time delay in succeeding peak systolic rotation, hampering also the consequent untwisting-diastolic period.