JCMR 2020; 22:25. Myocardial structural and functional changes in patients with liver cirrhosis awaiting liver transplantation: A comprehensive cardiovascular magnetic resonance and echocardiographic-Article

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This study examined whether liver cirrhosis causes structural as well as functional heart changes, and whether these changes improve after liver transplantation. Thirty-three patients with cirrhosis awaiting transplant and 20 healthy controls underwent echocardiography, ECG, and cardiovascular magnetic resonance (CMR), including extracellular volume fraction (ECV) measurement. Nineteen patients were re-evaluated 1 year after transplantation.<br /><br />At baseline, cirrhosis patients showed a hypercontractile left ventricle: left ventricular ejection fraction and global longitudinal strain (GLS) were higher than in controls. Standard measures of LV size, wall thickness, and many diastolic indices were not markedly different, and nearly half of patients could not be clearly classified for diastolic dysfunction by current echocardiographic criteria. QTc interval was prolonged, indicating electrical abnormalities.<br /><br />The key structural finding was increased myocardial ECV on CMR, suggesting diffuse myocardial extracellular expansion, likely representing diffuse myocardial fibrosis. Only one patient had focal late gadolinium enhancement, so the abnormality was mostly diffuse rather than focal. ECV correlated positively with Child-Pugh score, meaning worse liver disease was associated with more myocardial expansion. Native T1 was also elevated, but ECV appeared to be the more reliable marker.<br /><br />After liver transplantation, several abnormalities improved: ECV normalized, GLS and other strain measures decreased toward normal, QTc shortened, and LV dimensions and mass fell. These changes suggest that the myocardial alterations are at least partly reversible and related to liver failure.<br /><br />Overall, the study supports cirrhotic cardiomyopathy as a condition involving both functional hypercontractility at rest and a structural component—myocardial extracellular expansion—that improves after transplant.

Keywords

liver cirrhosis

cirrhotic cardiomyopathy

liver transplantation

echocardiography

cardiovascular magnetic resonance

extracellular volume fraction

myocardial fibrosis

global longitudinal strain

QTc prolongation

diastolic dysfunction