LETTER TO THE EDITOR
Cardiac dysfunction related to cirrhosis
Odilson Marcos SilvestreI; Alberto Queiroz FariasII; Fernando BacalI
IInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
IIHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
Mailing Address Mailing address: Odilson Marcos Silvestre Rua Oscar Freire, 1.967, apto. 10B, Pinheiros Postal Code 05409-011, São Paulo - SP - Brazil E-mail: odilsonsilvestre@yahoo.com.br, odilsonsilvestre@cardiol.br
Keywords: Heart Diseases / complications; Heart Disease / physiopathology; Liver Cirrhosis / complications; Liver Cirrhosis / physiopathology; Echocardiography.
Dear Editor,
A systematic review of Mota and Markman Filho1 demonstrates that Doppler echocardiography is indicated in cases of cirrhosis, for investigation of pulmonary and vascular complications of cirrhotic cardiomyopathy. We agree that this test may show cardiac abnormalities related to cirrhosis. In our experience, 184 patients prospectively evaluated showed structural cardiac abnormalities at rest, which correlated with the severity of cirrhosis2. However, the presence of these abnormalities is not sufficient to characterize cirrhotic cardiomyopathy. The criteria for diagnosis are not yet established or validated internationally. Clinical manifestations occur in conditions of stress. At rest, the heart is functionally normal. Hence, Doppler echocardiography at rest is often insufficient to characterize cirrhotic cardiomyopathy.
References
Manuscript received April 16, 2013; manuscript revised April 16, 2013; accepted May 10, 2013.
Reply
We are thankful to the statements of Silvestre et al1, with which we agree and have mentioned in the introduction to our manuscript. Recent reviews2,3 that address this issue describe a number of abnormalities on Doppler echocardiography at rest, characterizing cirrhotic cardiomyopathy: E/A ratio < 1; E wave deceleration time > 200 ms, isovolumic relaxation time > 80ms, increased left atrial volume, decreased left ventricular contractility, presence of wall hypokinesia and/or akinesia, increased myocardial mass, lowered ejection fraction (< 55%), among others.
Sincerely,
Vitor Gomes Mota
Brivaldo Markman Filho
References
Correspondência:
Odilson Marcos Silvestre
Rua Oscar Freire, 1.967, apto. 10B, Pinheiros
CEP 05409-011, São Paulo - SP - Brasil
E-mail: odilsonsilvestre@yahoo.com.br, odilsonsilvestre@cardiol.br
Artigo recebido em 16/04/13; revisado em 16/04/13; aceito em 10/05/13.
Carta-resposta
Agradecemos as colocações de Silvestre e cols.1, com as quais concordamos, fato este já citado na introdução do nosso artigo. Revisões recentes2,3 que abordam o tema descrevem uma série de anormalidades ao ecodopplercardiograma de repouso, caracterizando a cardiomiopatia cirrótica: relação E/A < 1, : tempo de desaceleração da onda E > 200 ms, tempo de relaxamento isovolumétrico > 80ms, aumento do volume atrial esquerdo, diminuição da contratilidade do ventrículo esquerdo, presença de hipocinesia e/ou acinesia de parede, aumento da massa miocárdica, fração de ejeção rebaixada (< 55%), entre outras.
Atenciosamente,
Vitor Gomes Mota
Brivaldo Markman Filho
Referências
- 1. Mota VG, Markman Filho B. Echocardiography in chronic liver disease: systematic review. Arq Bras Cardiol. 2013 Mar 22. [Epub ahead of print]
- 2. Silvestre OM, Bacal F, de Souza Ramos D, Andrade JL, Furtado M, Pugliese V, et al. Impact of the severity of end-stage liver disease in cardiac structure and function. Ann Hepatol. 2013;12(1):85-91.
- 1. Mota VG, Markman Filho B. O ecoDopplercardiograma na doença hepática crônica: revisão sistemática. Arq Bras Cardiol. 2013 Mar 22. [Epub ahead of print]
- 2. Zardi EM, Abatte A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW, et al. Cirrhotic cardiomyopathy. J Am Coll Cardiol. 2010;56(7):539-49.
- 3. Moller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53(1):179-90.
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Publication Dates
-
Publication in this collection
09 Sept 2013 -
Date of issue
Aug 2013