Severity of liver disease is associated with cirrhotic cardiomyopathy: A multicenter study

Cirrhotic cardiomyopathy (CCM) is subclinical cardiac dysfunction in patients with cirrhosis in the absence of overt coronary artery, valvular, or pericardial disease. Several complications of cirrhosis, including HRS-AKI and ascites, are postulated to be exacerbated by the presence of CCM. Among patients with cirrhosis, the association between the severity of liver disease and features of CCM and its presence has yet to be well characterized. We performed a retrospective study of adult patients with cirrhosis who underwent liver transplant (LT) at 2 tertiary LT centers between 2015 and 2018. Echocardiographic studies obtained prior to LT were examined. Echocardiographic marker(s) of CCM were present in 347 patients. CCM status was determined in 208 of the 347 patients. Demographics, etiology of liver disease, liver disease severity indices (Child-Turcotte-Pugh, CTP; Model for End-Stage Liver Disease-Na, MELD-Na), and comorbidities were examined in multivariable models to assess their associations with pre-LT CCM presence and its component features. CCM was present in 48/208 (23%) patients. In multivariable models, the presence of moderate-to-severe ascites (aOR 2.4, p =0.043) and MELD-Na (aOR 1.22 per 5-point increase in MELD-Na, p =0.046) were associated with CCM. Moderate-to-severe ascites, higher MELD-Na, and CTP score were associated with component features of CCM (left ventricular ejection fraction, left atrial volume index, E/e', and septal e') after adjusting for confounders; higher MELD-Na and CPT scores were also associated with TrVMax. While patients with higher CTP, MELD-Na, and moderate-to-severe ascites were at elevated risk of HRS-AKI, the presence of CCM and its individual markers were not independently associated with HRS-AKI. In conclusion, among patients with cirrhosis who were LT candidates, the severity of liver disease was associated with the presence of CCM and its echocardiographic features. These data may inform patient selection and encourage early detection of CCM among patients with cirrhosis.