Clinical significance of resting and dobutamine stress myocardial work in cirrhotic cardiomyopathy.

BackgroundMyocardial work (MW), an emerging measure of cardiac function, has not been assessed in cirrhotic cardiomyopathy (CCM) unlike global longitudinal strain (GLS).AimsTo evaluate MW in cirrhosis with transthoracic echocardiography (TTE) and dobutamine stress echocardiography (DSE); to study association of MW and CCM with a composite study outcome (one or more of acute kidney injury/hepatorenal syndrome, refractory ascites, cardiac failure, death); to assess the utility of cardiac biomarkers (NT-pro-BNP and cardiac troponin T) in the diagnosis of CCM; and to re-assess cardiac function at 12 months of LT.MethodsDesign: Prospective study.ParticipantsDecompensated liver cirrhotic patients with ascites and those undergoing liver transplant (LT) assessment from January 2021 to August 2022 with a 12-month follow-up.StudyTTE- and DSE-reported systolic and diastolic parameters as well as GLS and MW indices were calculated.Results96 patients, mean ± SD age 56 ± 11 years (58% male; 59% alcohol misuse) with Model for End-stage Liver Disease Sodium (MELD-Na) 17 ± 7 were studied. During the follow-up, 16 underwent LT; 53 developed the study outcome. CCM was diagnosed in 26 (27%), and it had no association with study outcome. MW was decreased in patients with CCM, and there was no augmentation of GLS or MW on DSE. MELD-Na. GLS, MW indices and septal E/e' were higher in patients meeting the study outcome. MELD-Na and septal E/e' were independent predictors of the study outcome. There was no association between biomarkers and CCM. Ten patients evaluated post LT demonstrated significant reductions in GLS and MW.ConclusionsMW was decreased in patients with CCM. Neither MW indices nor a diagnosis of CCM was predictive of the study outcome. Liver disease severity measured by MELD-Na score and E/e' were independent predictors of the study outcome. Although MW is a load-independent measure, in this study, it did not add to the diagnosis CCM more than GLS. Further large-scale studies are required to establish the role of MW in evaluation of patients with liver cirrhosis.