O papel do <i>speckle tracking</i> na detecção ecocardiográfica da disfunção cardíaca subclínica em pacientes com cirrose

Abstract

Cirrhosis is a disease with high prevalence related to hemodynamic changes that can lead to cardiac dysfunction. The speckle tracking, a new echocardiographic method for assessment of cardiac function, has proved to be highly sensitive in detecting subclinical systolic dysfunction. The aim of this cross-sectional study was to determine the role of echocardiographic evaluation of bidimensional strain for detecting subclinical ventricular dysfunction in cirrhosis patients. Echocardiographic data were acquired in 78 patients with cirrhosis of varying severity (Child-Pugh-Turcotte class A: 30, B: 30, C: 18) and 46 age- and sex-matched control subjects. Classic parameters of systolic and diastolic cardiac function; radial, circumferential, and longitudinal strain; and left ventricular (LV) myocardial torsion/twist were compared using speckle tracking. Classic systolic parameters demonstrated no differences in cardiac output (cirrhosis: 8.7 L/min, control: 7.8 L/min, p = 0.7), cardiac index (cirrhosis: 5.01 L/min/m2, control: 4.44 L/min/m2, p = 0.65), septal S wave tissue Doppler velocity (cirrhosis: 8.06 cm/s, control: 8.06 cm/s, p = 0.99), and ejection fraction determined by Simpson method (cirrhosis: 63.42%, control: 63.91%, p = 0.82). Among diastolic parameters, E/A ratio (cirrhosis: 1.16, B: 1.19, p = 0.72) and M-color Doppler (cirrhosis: 74.67 cm/s, control: 73.75 cm/s; p = 0.85) did not differ, while E/Em lateral wall (cirrhosis: 9.47, control: 7.0, p = 0.009), E wave deceleration time (cirrhosis: 239,7 ms, control: 191.30 ms, p < 0.001), indexed left atrial volume (cirrhosis: 31.67 mL/m2, control: 24.37 mL/m2, p < 0.001), and indexed LV diastolic volume (cirrhosis: 47.59 mL/m2, control: 40.0 mL/m2; p = 0.004) significantly differed between groups with higher values in cirrhotic. Analysis of deformation of the LV indicated no difference in global longitudinal strain (cirrhosis: -20.43%, control: -20.39%, p = 0.83), global circumferential strain (cirrhosis: -19.69, control: -19%, p = 0.32), strain rate (cirrhosis: -1.20, control: -1.15, p = 0.10), or global longitudinal RV strain (cirrhosis: -20.6%, control: -20.83%, p = 0.94), but a significant difference in radial strain (cirrhosis: 52,17%, control: 44.94%, p = 0.03), LV twist (cirrhosis: 10.44°, control: 13.02°, p = 0.008), and LV myocardial torsion (cirrhosis: 1.38°/cm, control: 1.82°/cm, p = 0.008). In conclusion, patients with cirrhosis have increased radial deformation, but poorer twist/LV torsion in relation to control subjects. This finding suggests the presence of subclinical systolic dysfunction in patients with cirrhosis and that speckle tracking can play an important role in its detection (Clinical Trial: NCT01433848).