| Objective:Cardiac insufficiency caused by cirrhosis was first described more than 50 years ago and first defined as cirrhosic cardiomyopathy in 1989,characterized by impairment of systolic and diastolic function of the heart,abnormal electrophysiological activity,etc.Studies have found that CCM occurs in nearly 40% of patients with cirrhosis,and is closely related to complications such as abdominal effusion and hepatorenal syndrome in patients with cirrhosis,which has a great impact on the risk and prognosis of surgical operations.Studies in recent years have found that the function of the right ventricle declines earlier than the left ventricle in patients with cirrhosis,and the evaluation of right ventricular function in patients with cirrhosis is better than the left ventricle in predicting the poor prognosis of patients such as orthotopic liver transplantation and transjugular intrahepatic portal vena caval shunting.Therefore,the purpose of this project is to study the changes of systolic and diastolic function of the right ventricle in patients with liver cirrhosis,observe the changes in the morphology,structure and function of the right ventricle in patients with liver cirrhosis of different severity,and detect the damage of right ventricular myocardium in time,so as to take treatment measures as soon as possible,to prevent the occurrence of heart failure.Methods:The study subjects were patients with cirrhosis who visited the Department of Gastroenterology,Hepatobiliary and Pancreatic Surgery and Interventional Department of the First Hospital of Shanxi Medical University from August 2021 to April 2022,and 90 patients with cirrhosis were selected as the experimental group,including 52 female patients and 38 male patients.Patients with cirrhosis were divided into group A(≤9 points),group B(10～19 points),and group C(≥20 points)according to the end-stage liver disease model score(MELD),and 40 healthy volunteers who met the requirements were included as the control group.The specific method is as follows:1.General clinical data1.1 Basic data of the study subjects were collected,including age,BMI,blood pressure,and heart rate.1.2 Comparison between groups with cirrhosis: Compared with group A,the values of AST,ALT,Scr,TBil and INR in groups B and C were increased statistically significantly(all P < 0.05),and compared with group B,the values of AST,ALT,Scr,TBil and INR were increased and the differences were statistically significant(all P < 0.05).2.Blood biochemical testThe most recent biochemical indexes were collected,including aspartate aminotransferase(AST),alanine transaminase(ALT),total bilirubin(TBil),prothrombin time(PT),serum creatinine(Scr),International normalized ratio(INR).3.Echocardiography3.1 Two-dimensional structure and functional parameters of the right ventricleVentricular septum(IVS),right ventricular anteri wall thickness(RVAW),right ventricular free wall thickness(RVFW),and right ventricular outflow tract inner diameter(RVRICULAR)were measured in the experimental and control groups outflow tract diameter(RVOT),Right ventricular myocardial pergormance(RIMP),Early diastolic blood flow of tricuspid valve(Et),and late tricuspid diastolic blood flow velocity(Late diastolic flow of tricuspid valve(At),peak tricuspid annulus early diastolic velocity(E’),Et wave deceleration time(Et DT),and calculated Et/At,Et/E’.3.2 Right ventricular two-dimensional spot tracking strain parametersCompared with group A,the absolute values of Bas-RVSL,Med-RVSL,Api-RVSL and RC4 CSL were reduced between groups B and C(all P < 0.05),the absolute values of RVFWSL in group C were lower than those in group A,and the absolute values of Bas-RVSL,Api-RVSL,RV4 CSL and RVFWSL were reduced(all P <0.05);compared with group B,the absolute values of Bas-RVSL,Api-RVSL,RV4 CSL and RVFWSL were reduced in group C.The difference was statistically significant(all P < 0.05).3.3 Right ventricular three-dimensional echocardiogram parametersThe diameter of right ventricular end-diastolic basal segment(RVDd-base),the diameter of right ventricular end-diastolic middle segment(RVDd-mid),and the right ventricular anteroposterior diameter(RVDd-mid)were measured ventricular anteroposterior diameter(RVLD),right ventricular ejection fraction(RVEF),tricuspid annular plane systolic excursion(TAPSE),right ventricular area change fraction(RIGHT).ventricular fractional area change(RVFAC).Results:1.Comparison of general clinical data and blood biochemical testsThere were no significant differences in age,BMI,blood pressure and heart rate between the cirrhosis group and the control group.The AST,ALT,SCR,TBil and INR in the cirrhosis group were higher than those in the control group,and the differences were statistically significant(all P < 0.05).2.Comparison of two-dimensional structure and functional parameters of right ventricle2.1 Comparison between cirrhosis group and control group: IVS,RVAW,RVFW and Et/E’were higher in cirrhosis group than in the control group,and Et/At was lower than that in the control group,and the difference was statistically significant(all P <0.05).Compared with the control group,Et/At decreased and Et/E’ increased in group A(P<0.05).2.2 Comparison between groups with cirrhosis: Compared with group A,Et/E’,At,and RIMP were increased in group B with significant differences(all P <0.05),Et,Et/At,and Et DT were reduced and RIMP was increased in group C(all P <0.05),and compared with group B,Et,Et/At,and Et DT were increased and RIMP was increased and the difference was statistically significant(all P <0.05).3.Comparison of strain parameters of two-dimensional spot tracking in the right ventricle3.1 Compared with the control group,the absolute values of Bas-RVSL,Med-RVSL,Api-RVSL,RV4 CSL and RVFWSL in the cirrhosis group were lower than those in the control group,and the difference was statistically significant(all P <0.05).3.2 Compared with group A,the absolute values of Bas-RVSL,Med-RVSL,Api-RVSL and RC4 CSL were significantly reduced between groups B and C(all P <0.05);compared with group B,the absolute values of Bas-RVSL,Api-RVSL,RV4 CSL and RVFWSL were reduced in group C(all P <0.05);the absolute value of RVFWSL was significantly reduced in group C compared with group A(all P <0.05).4.Comparison of three-dimensional echocardiogram parameters of right ventricle4.1 Compared with the control group,TAPSE,RVEF and RVFAC were reduced,and RVDd-base was increased,and there were statistical differences(all P <0.05).4.2 Compared with group A,TAPSE,RVEF and RVFAC were reduced and RVDd-base increased in groups B and C(all P < 0.05);compared with group B,TAPSE,RVEF and RVFAC were reduced and RVDd-base increased in group B(all P < 0.05).Conclusion:1.Patients in the cirrhosis group changed the morphological structure of the right ventricle,the inner diameter of the right ventricular chamber increased,the free wall and anterior wall of the right ventricle thickened,and the ventricular septum thickened.2.Compared with cirrhosis groups: with the increase of MELD score,the degree of impaired diastolic function of the right ventricle gradually worsened;In the early stage of cirrhosis,the right ventricular systolic function was not significantly changed,and the systolic function decreased significantly in the middle and late stages of cirrhosis. |
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