Prevalence and Prognostic Value of Cirrhotic Cardiomyopathy as Defined According with the Proposed New Classification - European Medical Journal

Prevalence and Prognostic Value of Cirrhotic Cardiomyopathy as Defined According with the Proposed New Classification

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EMJ Hepatology 9.1 Feature Image
*Maurizio Cesari,1 Anna Chiara Frigo,2 Salvatore Piano,1 Paolo Angeli1

The authors have declared no conflicts of interest.


The authors would like to acknowledge Antonella Cecchetto for her precious contribution to the assessment of global longitudinal strain.

EMJ Hepatol. ;9[1]:28-29. Abstract Review No. AR1..
Cardiomyopathy, cirrhosis, cirrhotic, diastolic dysfunction, echocardiography, strain, systolic function.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


The prevalence and prognostic relevance of cirrhotic cardiomyopathy (CCM), as defined according with the new core criteria proposed in 20191 is still unknown. The authors investigated this relevant issue in a large cohort of cirrhotic patients in different stages of liver disease.


The authors retrospectively interrogated a data set of 162 collected cirrhotic patients followed up for at least 6 years, which at baseline underwent standard Doppler echocardiography and were compared with 46 healthy subjects. Left ventricular (LV) geometry, systolic/diastolic function, global longitudinal strain and the main haemodynamic parameters were assessed according with current guidelines.

Systolic dysfunction was diagnosed if LV ejection fraction ≤50%, and/or GLS <18% or >22%. Advanced diastolic dysfunction was diagnosed if ≥3 of the following: left atrial volume index >34 mL/m2, tricuspid regurgitation velocity >2.8 m/sec, early diastolic peak velocity of septal mitral annulus (septal e’) velocity <7 cm/sec, early diastolic transmitral and myocardial velocity on tissue Doppler imaging ratio (E/e’) >15, as proposed in the new criteria.1


Adequate echocardiographic images permitting speckle tracking analysis were available in 83 patients. No patient presented LV ejection fraction ≤50%; GLS <18% or >22% was evident in 25%; advanced diastolic dysfunction was evident in 10%. Overall the prevalence of CCM was 29%. Patients with and without CCM presented similar clinical, biochemical, haemodynamic and echocardiographic features at baseline, and similar incidence of death and/or hepatorenal syndrome after 6 years follow-up (see Table 1).

Table: Clinical, demographic, and biochemical features of cirrhotic patients with and without cirrhotic cardiomyopathy.
The data are reported as mean±SD or median (and interquartile range) as appropriate.
HRS: hepatorenal syndrome; MAP: mean arterial pressure: NA, not available; NS: non-significant.


According with the new criteria CCM was detected in 29% of patients, mainly due to altered GLS at rest, but without prognostic relevance and therefore not optimal for the clinical management of cirrhotic patients.

Izzy M et al. Redefining cirrhotic cardiomyopathy for the modern era. 2020;71(1):334-45. Erratum in: Hepatology. 2020;72(3):1161.

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