Mechanical Function Injury Evaluation Of Left Ventricular Myocardium In Patients With Liver Cirrhosis By Ultrasonic Pressure-Strain Loop

Objective:This study aimed to explore the changes of left ventricular myocardial work(LVMW)using the ultrasonic pressure-strain loop(PSL),and to reveal the potential myocardial mechanical dysfunction in patients with liver cirrhosis.Methods:Eighty-two patients with liver cirrhosis without known cardiovascular disease diagnosed in Sichuan Provincial People’s Hospital from October 2020 to March 2021 were enrolled for this study,of which thirty-eight were assigned to the compensated group and forty-four were assigned to the decompensated group according to whether they were combined with the complications of portal hypertension.Other forty-seven healthy volunteers matched in age and sex were randomly recruited as the control group.Left ventricular(LV)traditional structural and functional parameters were measured by the conventional echocardiography.The LVMW was calculated by the PSL,which is based upon the estimated LV pressure combined with the myocardial strain obtained by two-dimensional speckletracking technique.The main parameters as follows:global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE),and the basal segment myocardial work(WIba,CWba,WWba,WEba),papillary muscle segment myocardial work(WIpm,CWpm,WWpm,WEpm),apical segment myocardial work(WIap,CWap,WWap,WEap),global longitudinal strain(GLS),and peak strain dispersion(PSD).Then the differences in above parameters among the three groups were compared.Results:①Conventional echocardiography parameters:compared with the control group,the interventricular septum end-diastolic thickness(IVSTd),LV posterior wall end-diastolic thickness(LVPWd),LV mass(LVM),and LV mass index(LVMI)increased in the compensated group and decompensated group(all P<0.05),but there was no significant differences in conventional echocardiographic parameters between the compensated group and decompensated group(all P>0.05).②Global LVMW and strain parameters:both compensated and decompensated groups had significantly lower GWI,GCW,GWE,and GLS,and higher GWW and PSD than did the control group(all P<0.05).Moreover,GWI,GCW,and GLS in the decompensated group were further decreased compared with the compensated group(all P<0.05),whereas GWW,GWE,and PSD did not differ statistically(all P>0.05).③Regional LVMW parameters:compared with the control group,WIba,CWba,CWpm,WEpm,WIap,CWap,and WEap were decreased,while WWpm was increased in the compensated group(all P<0.05),and the LVMW of all segments in the decompensated group were significantly damaged(all P<0.05);compared with the compensated group,WIpm,CWpm,WIap,and CWap in the decompensated group were further decreased(all P<0.05).Conclusions:①Patients with compensated and decompensated liver cirrhosis both have different level of LV myocardial mechanical dysfunction.And the degree of myocardial injury may be related to the severity of the disease.As liver cirrhosis progresses from compensated stage to decompensated stage,the damage of LV systolic function is gradually aggravated.②The LVMW,measured by the PSL,may be useful for non-invasively and quantitatively assessing LV myocardial mechanical function,and provide a novel approach for the accurate diagnosis of myocardial injuries in liver cirrhosis.