Clinical significance of resting and dobutamine stress myocardial work in cirrhotic cardiomyopathy

BACKGROUND: Myocardial work (MW), an emerging measure of cardiac function, has not been assessed in cirrhotic cardiomyopathy (CCM) unlike global longitudinal strain (GLS). AIMS: To evaluate MW in cirrhosis with transthoracic echocardiography (TTE) and dobutamine stress echocardiography (DSE); to study association of MW and CCM with a composite study outcome (one or more of acute kidney injury/hepatorenal syndrome, refractory ascites, cardiac failure, death); to assess the utility of cardiac biomarkers (NT-pro-BNP and cardiac troponin T) in the diagnosis of CCM; and to re-assess cardiac function at 12 months of LT. METHODS: Design: Prospective study. PARTICIPANTS: Decompensated liver cirrhotic patients with ascites and those undergoing liver transplant (LT) assessment from January 2021 to August 2022 with a 12-month follow-up. STUDY: TTE- and DSE-reported systolic and diastolic parameters as well as GLS and MW indices were calculated. RESULTS: 96 patients, mean ± SD age 56 ± 11 years (58% male; 59% alcohol misuse) with Model for End-stage Liver Disease Sodium (MELD-Na) 17 ± 7 were studied. During the follow-up, 16 underwent LT; 53 developed the study outcome. CCM was diagnosed in 26 (27%), and it had no association with study outcome. MW was decreased in patients with CCM, and there was no augmentation of GLS or MW on DSE. MELD-Na. GLS, MW indices and septal E/e' were higher in patients meeting the study outcome. MELD-Na and septal E/e' were independent predictors of the study outcome. There was no association between biomarkers and CCM. Ten patients evaluated post LT demonstrated significant reductions in GLS and MW. CONCLUSIONS: MW was decreased in patients with CCM. Neither MW indices nor a diagnosis of CCM was predictive of the study outcome. Liver disease severity measured by MELD-Na score and E/e' were independent predictors of the study outcome. Although MW is a load-independent measure, in this study, it did not add to the diagnosis CCM more than GLS. Further large-scale studies are required to establish the role of MW in evaluation of patients with liver cirrhosis.