Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with non-alcoholic cirrhosis.

INTRODUCTION Cirrhosis is associated with certain abnormalities in left ventricular (LV) structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables a rapid and accurate analysis of regional LV systolic mechanics in the longitudinal, radial and circumferential directions. The aim of this study was to precisely assess the differences among the 3 directions in the early impairment of LV myocardial contraction in non-alcoholic cirrhotic patients with preserved LV pump function. METHODS A total of 75 subjects, including 38 cirrhotic patients and 37 healthy individuals, were enrolled. Using 2D-STE, the strain (S) and systolic strain rate (SRS) values belonging to the radial (R), circumferential (C), and longitudinal (L) functions of the LV were measured. RESULTS In the cirrhotic group, the LS (20.57 ± 2.1 vs. 28.7 ± 43.1, p<0.001) and LSR-S (1.1 ± 0.24 vs. 1.6 ± 0.3) values were found to be lower, whereas the CS (24.82 ± 2.57 vs. 19.16 ± 4.58, p<0.001) and CSRS (1.41 ± 0.3 vs. 1.2 ± 0.4, p<0.004) values were found to be higher than in the healthy control group. The RS and RSR-S values did not differ among the groups. A relationship was observed between the MELD score, which shows the severity of the disease, and the CS value (â: 0.211, p<0.01, 95%CI: 0.086-0.503). CONCLUSION LV myocardial contraction was impaired in the longitudinal direction. However, LV pump function was augmented by the circumferential shortening during the ventricular systole. Using the 2D-STE method for the regional evaluation of the LV, the LV damage can be detected in the subclinical phase in cirrhotic patients.