Cardiovascular predictors of death in patients with cirrhosis

Cirrhotic cardiomyopathy is associated with poor outcomes in patients with cirrhosis. We investigated if subclinical cardiac morphologic and functional modifications can influence survival in cirrhotic patients during follow-up. A series of cirrhotic patients without cardiovascular or pulmonary disease underwent standard and tissue Doppler echocardiography to assess left ventricular (LV) geometry, systo/diastolic function and the main haemodynamic parameters. After baseline evaluation 115 cirrhotic patients were followed up for at least 6 years. During follow up 54 patients died (47%). On univariate analysis age, BSA, MELD, mean arterial pressure, heart rate, cardiac index, systemic vascular resistance index, the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') were associated with increased risk of death. In a Cox hazard regression analysis including these factors and other hypothesized important factors (but not MELD) increased age (p=0.04) and left atrial dimension (p=0.005), and lower BSA (p=0.03) were the strongest predictors of death. When MELD was included in the analysis the main predictors were MELD, age and BSA. When multivariate analysis was performed incorporating only cardiovascular parametres, increased E/e' (p=0.003) and heart rate (p= 0.03) and reduced mean blood pressure (p= 0.01) resulted significantly associated with poor prognosis.