European Journal of Cardiovascular Medicine

Liver cirrhosis refers to a condition of progressive disease that damages the normal architecture of the liver and it is caused by a number of conditions. The altered liver architecture causes fibrosis and distorted vasculature resulting in portal hypertension and its complications.”Loss of functioning hepatocellular mass and portal hypertension may lead to varices and other liver cell failure signs like jaundice, edema, ascites, coagulopathy and a variety of metabolic abnormalities. The involvement of cardiovascular system in cirrhosis is crucial due to its pathophysiological, clinical and therapeutic relationships with the liver. ‘Cardiac cirrhosis’ refers to describe a constellation of features that indicate structural and functional abnormality of heart which are often secondary to liver cirrhosis. Liver cirrhosis affects cardiovascular system which results in systolic and diastolic dysfunction. Cardiovascular alterations are more frequent in the late stages of cirrhosis. Majority of patients have a subclinical latent cardiomyopathy with hyperdynamic circulation. Cirrhotic patients frequently undergo treatment for complications of cirrhosis like ascites, variceal bleeding, paracentesis, shunt surgeries and liver transplantation. During these procedures the latent form of cardiac dysfunction becomes overt heart failure increasing the mortality.So a stable cardiac status is necessary in all cirrhotic patients. Cardiac status may be assessed by various modalities like electro physiological studies, echocardiogram and biochemical parameters

The biochemical parameters are Atrial Natriuretic Peptide (ANP) and B-Type Natriuretic Peptide (BNP)and Cardiac Troponin I. BNP is a cardiac neurohormone secreted from ventricles in response to end diastolic pressure and volume overload.

Thickness of the left ventricular wall, diastolic dysfunction and stress induced systolic dysfunction are indicative of cirrhotic cardiomyopathy. BNP increases in correlation with severity of cardiac dysfunction.

Study design: Cardiac status may be assessed by varies modalities like electrophysiological studies, echo cardiogram and biochemical parameters.

Place of study: This study was conducted at General Medicine Department ,NRI Institute of medical sciences, sangivalasa, Andhra Pradesh.

Duration of study: The study was conducted from November 2022 to July 2023.

Sample population: 50subjects – 50 cases who were admitted in the medical wards of NRI HOSPITAL, VISAKHAPATNAM.

Selection Criteria:

Inclusion criteria:

1.patients diagnosed as cirrhosis of liver by

2.Ultrasonography

3. age 20 to 60 years

4.gender: both male and female

Exclusion criteria:

1.patients with h/o heart disease (valvular and ischaemic)

2.Hypertensives and diabetics

3. Thyroid disorders and pregnancy
4. Patients with electrolyte abnormalities

5.H/O arrhythmias and taking anti arrhythmic drugs.

6. On medications causing QT prolongation
7. Sepsis

8.Patients on chemotherapy

9. OCP intake

METHODOLOGY :

• A prospective and comparative study was conducted in ANIL NEERUKONDA HOSPITAL,VIZAG From may 2022 to may 2023.
• An ethical clearance was obtained from the ethical committee of the college and hospital.

• The end point of liver disease ,so called liver cirrhosis affects many organ systems in the body. cardiovascular complications can occur in liver cirrhosis without any underlying cardiac disease which includes blunted ventricular response to stimuli,systolic and diastolic dysfunction and absence of overt heart failure at rest .
• Serum brain natriuretic peptide levels and prolonged QTc interval is an important finding in cirrhosis. serum BNP levels had linear correlation with QTc prolongation and Left ventricular end diastolic dimension (LVEDD).serum BNP levels progressively increased from child pugh class A to C.
• In our study about 60 percent had alcoholism as etiology of cirrhosis ,remaining were viral and other etiologies. The incidence of cardiovascular complications in cirrhosis was not significant with respect to etiology of cirrhosis.

• The frequency of high serum BNP levels was statistically significant with worsening child Pugh score. It indicates an association between serum BNP levels with severity of cirrhosis.
• Serum BNP levels was linearly correlating with prolonged QTc interval and left ventricular end diastolic dimension (LVEDD).
• This indicates a relationship between biochemical and electrophysiological problems in overloaded heart with cirrhotic cardiomyopathy.
• There was no significant correlation with gender and different etiology with serum BNP levels.
• Thus serum BNP can be considered for its use in detecting overt heart failure in cirrhotic patients.

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