CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 175 Combined systolic velocities using tissue Doppler imaging could predict the severity of cirrhosis: a prospective cohort study Ibrahim Dönmez, Emrah Acar Abstract Aim: Recent research has demonstrated that the contractile characteristics of the right ventricular outflow tract (RVOT) play a significant role in right ventricular function. Pulmonary annular motion velocity (PAMVUT) is a reliable marker of RVOT function. Also, combined systolic velocity [PAMVUT added to tricuspid annular systolic velocity (St)] has been revealed as a suitable parameter for right ventricular systolic function. In this study, we examined the association between the severity of the illness in cirrhotic patients and the combined S velocities (CSV). Methods: Seventy-four patients with cirrhosis went to the echocardiography laboratory of the Cardiology Department in our centre. Traditional echocardiographic measurements, PAMVUT and CSV values were recorded. The Child–Pugh classes of the patients were determined. Results: Receiver operating characteristic curve analysis demonstrated that a CSV of 23 cm/s constituted the cut-off value for predicting a moderate-to-severe form of cirrhosis with 76% sensitivity and 65.3% specificity (area uder the curve = 0.735, p < 0.001). Conclusion: CSV values could predict the severity of cirrhosis more precisely than traditional right ventricular systolic function parameters. Keywords: cirrhosis, Doppler, echocardiography, right ventricle Submitted 15/3/23, accepted 19/6/23 Published online 14/7/23 Cardiovasc J Afr 2023; 34: 175–180 www.cvja.co.za DOI: 10.5830/CVJA-2023-034 Chronic liver disease (CLD) is common and widespread throughout the world.1 A link has been discovered between liver dysfunction and the cardiovascular system.2 Cirrhotic cardiomyopathy (CCM) is the term used to describe the relationship between CLD and the cardiovascular system.3 Regardless of the cause, worsening in liver function is related to structural and functional cardiac abnormalities.4 The pathogenesis of CCM and the hepatopulmonary syndrome is mediated by an increase in nitric oxide and other inflammatory mediators, which result in splanchnic vasodilatation and impaired arterial compliance.4,5 The diagnosis of CCM is typically only made in the last stages of CLD in individuals with CLD, which results in underdiagnosis.6 Hyperdynamic circulation with reduced arterial blood volume, CCM and pulmonary arterial hypertension are only a few circulatory and pulmonary problems linked to advanced liver cirrhosis.7 Hepatopulmonary syndrome and portopulmonary hypertension are pulmonary effects of hyperdynamic circulation and portal hypertension. The majority of research on cirrhotic patients has been on left ventricular (LV) function, which is typically assessed by tissue Doppler echocardiography.6 Nonetheless, in these individuals, overt cardiac failure is typically not identified until cardiac dysfunction has been present for a specific time.8 Right ventricular (RV) dysfunction has been linked to the prognosis of patients with cirrhosis and many of these patients show signs of RV dysfunction.9 As a result, determining RV and LV function in cirrhosis patients is critical.8,10 Most studies on alterations in right heart function in individuals with cirrhosis have focused on traditional markers of RV dysfunction.11-14 The right ventricle, however, resembles a pyramid, and measures, such as tricuspid annular plane systolic excursion (TAPSE), S, fractional area change (FAC) and speckle-tracking-derived global longitudinal strain (GLS) offer details on the longitudinal movement of the free wall of the right ventricle. These traditional metrics again disregard the right ventricle’s pyramidal characteristic. Recent research has demonstrated that the contractile characteristics of the RV outflow tract (RVOT) play a significant role in RV function.15,16 An important marker of the systolic function of the RVOT is pulmonary annular motion velocity (PAMVUT).17 A recent article demonstrated that combined systolic velocities (CSV), calculated with PAMVUT and tricuspid annular systolic velocity (St), was a significant prognostic marker in patients with acute coronary syndrome.18 We have not found research in the literature that looked at RVOT functioning in patients with cirrhosis. In this work, we examined the association between the severity of the illness in patients with cirrhosis and the CSV. Methods This study was approved by the local ethics committee (ethics number: 2022/114, decision date: 26.04.2022). The research was conducted in conformity with the standards of the Helsinki Declaration. All patients who participated in this trial provided written, informed consent. Between 1 January 2018 and 1 January 2022, 74 consecutive hepatic cirrhosis patients were sent from the Gastroenterology Medical School, Bolu Abant Izzet Baysal University, Bolu, Turkey Ibrahim Dönmez, MD Emrah Acar, MD, dreacar44@hotmail.com
RkJQdWJsaXNoZXIy NDIzNzc=