Clinical Utility of Child Pugh Class for Myocardial Dysfunction in Chronic Liver Disease Patients

Background: Chronic liver disease is progressive destruction of liver parenchyma over a period of 6 months leading to fibrosis and cirrhosis .Clinical course of patients with chronic liver disease is complicated by progressive impairment of circulatory function. Three major pathophysiologic features of cardiac dysfunction of these patients are – structural and functional ventricular abnormality (in form of left ventricular hypertrophy and diastolic dysfunction, electrophysiological abnormality (prolonged corrected QT interval), ventricular dysfunction in response to stress or exercise. Objectives: To evaluate the echocardiographic changes in chronic liver disease patients and to correlate the severity of chronic liver disease according to child – pugh class with cardiac dysfunction. Study design: Observational Cross sectional study design. Materials and Methods: 100 patients with chronic liver disease were included. All the study participants were subjected to do routine blood investigations and ultrasound scan abdomen to confirm the diagnosis of chronic liver disease. The parameters that were assessed in echocardiography are E/A ratio, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction. QTc interval more than 440 msec and E/A ratio less than 1 were considered diagnostic of cirrhotic cardiomyopathy. Results: Out of 100 patients studied, 81% were males. The mean years of age of the patients were 44.4 + 7.32. The Mean years of duration of illness was 2.38 +1.57years. Alcohol was the leading etiological cause followed by hepatitis. Association between Child Turcotte Pugh Class B& C and myocardial dysfunction were found to be significant. Conclusions: Patients with Child-Pugh C cirrhosis showed increased systolic and diastolic myocardial dysfunction and also longer QT interval than Child-Pugh A or B patients. Thus, an evaluation of myocardial function should be considered in patients with chronic liver disease especially for Child- pugh class C.