CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 178 AFRICA It was found that conventional echocardiographic measures were normally distributed. Detailed information is given in Table 3 for one-way ANOVA analyses. Statistically significant results for FAC (p = 0.001), PAMVUT (p = 0.003), St (p = 0.006) and CSV (p = 0.001), and Tukey’s multiple comparison post hoc tests for FAC, PAMVUT and CSV showed that class A was significantly higher than class B and C, while no significant difference was observed between class B and class C. For St, class A significantly outperformed class B (p = 0.025). To facilitate further comparison between CSV and St, Fig. 2 is provided. In a univariate correlation study of RV echocardiographic parameters, CSV was shown to have a positive relationship with TAPSE (r = 0.350, p = 0.002), FAC (r = 0.458, p = 0.001), St (r = 0.884, p = 0.001) and PAMVUT (r = 0.855, p = 0.001) (Table 4). The receiver operating characteristic (ROC) curve analysis demonstrated that a CSV of 23 cm/s cut-off value for predicting moderate-to-severe forms of cirrhosis (Child–Pugh class B and C) had a 76% sensitivity and 65.3% specificity (area under the curve = 0.735, p < 0.001) (Fig. 3). Discussion We have shown in this study that RVOT function can predict the severity of cirrhosis. Cirrhosis has previously been shown to impair left heart function, and several echocardiographic predictions may be linked to severity of cirrhosis.4,7,9,12 Recent research has revealed that individuals with cirrhosis may also experience right cardiac dysfunction.11-14 In this study, conventional right heart function descriptors were applied. Most of these parameters, highlighted in the research, are longitudinal function indicators (such as TAPSE and St) computed over the RV free wall and tricuspid annulus. The fact that the right ventricle has a very complicated anatomical structure has revealed that it also has a functional structure. Table 3. Echocardiography findings of patients using one-way ANOVA test Child–Pugh class A (n = 49) Child–Pugh class B (n = 21) Child–Pugh class C (n = 4) p-value LVEF, % 61.67 ± 5.09 60.90 ± 4.76 61.25 ± 2.50 0.83 LA, cm 3.50 ± 0.28 3.59 ± 0.39 3.72 ± 0.22 0.28 IVS, cm 1.03 ± 0.14 1.09 ± 0.13 1.05 ± 0.12 0.21 LVEDD, cm 4.52 ± 0.33 4.43 ± 0.28 4.82 ± 0.43 0.09 LVESD, cm 2.71 ± 0.48 2.61 ± 0.53 3.02 ± 0.42 0.32 PW, cm 1.16 ± 0.10 1.09 ± 0.10 1.05 ± 0.10 0.91 E, mm/s 83.04 ± 13.47 84.80 ± 22.79 86.50 ± 10.24 0.87 A, mm/s 79.93 ± 19.44 80.09 ± 16.89 72.50 ± 12.60 0.74 E′, mm/s 11.80 ± 2.27 11.09 ± 1.49 11.40 ± 2.57 0.44 A′, mm/s 13.14 ± 2.38 13.13 ± 1.66 11.65 ± 1.44 0.41 E/e′ 7.28 ± 1.76 7.89 ± 2.78 7.90 ± 1.98 0.49 TAPSE, mm 24.58 ± 2.35 23.40 ± 2.52 23.25 ± 1.89 0.13 FAC, % 39.43 ± 5.55a 34.71 ± 4.99b 31.75 ± 2.50b 0.001 sPAP, mm Hg 23.73 ± 4.03 25.00 ± 5.68 27.00 ± 6.27 0.29 PAMVUT, cm/s 10.10 ± 1.69a 9.09 ± 1.30b 7.75 ± .50b 0.003 St, cm/s 14.58 ± 1.77a 13.39 ± 1.50b 12.50 ± 1.91ab 0.006 CSV, cm/s 24.67 ± 2.95a 22.57 ± 2.50b 20.25 ± 2.36b 0.001 LVEF: left ventriculer ejection fraction, LA: left atrium, IVS: interventricular septum, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular end-systolic diameter, PW: posterior wall, E: early ventricular filling velocity, A: late ventricular filling velocity, E′: ventricular tissue Doppler early diastolic velocity, A′: ventricular tissue Doppler late diastolic velocity, TAPSE: tricuspid annular plane systolic excursion, FAC: fractional area change, sPAP: systolic pulmonary artery presssure, PAMVUT: pulmonary annulus motion velocity, St: tricuspid annulus systolic velocity, CSV: combined S velocities. Values within each row sharing a common superscript are significantly different (p < 0.05), as determined by Tukey’s post hoc test. p = 0.025 cm/s A B C A B C 20 15 10 5 0 Child–Pugh class Child–Pugh class St p = 0.015 cm/s 30 20 10 0 CSV p = 0.001 Fig. 2. Severity of disease association with St and CSV. Vertical bars are mean ± SD, p-values were obtained via Tukey’s post hoc test. Table 4. Correlation of CSV with RV echocardiographic measurements Variables CSV r p-value TAPSE, cm 0.350 0.002 FAC, % 0.458 0.001 St, cm/s 0.884 0.001 PAMVUT, cm/s 0.855 0.001 TAPSE: tricuspid annular plane systolic excursion, FAC: fractional area change, St: tricuspid annular systolic velocity, PAMVUT: pulmonary annulus motion velocity, CSV: combined S velocities. CSV Sensitivity Specificity 0 20 40 60 80 100 100 80 60 40 20 0 Sensitivity: 76.0 Specificity: 65.3 Criterion: ≤ 23 AUC = 0.735 p < 0.001 Fig. 3. ROC curve analysis of CSV; severe and moderate groups were combined. In the ROC analysis, a CSV of 23 cm/s predicted severe chirrosis with a 76% sensitivity and 65.3% specificity (area under the curve = 0.735, p < 0.001).
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