Evaluation of subclinical myocardial dysfunction with global longitudinal strain and 4D strain in patients with liver cirrhosis

Liver cirrhosis is a multisystemic disease characterized by hyperdynamic circulation, and disorders involving many organs occur in its course. Studies have found that the frequency of autonomic dysfunction is increased in cirrhotic patients; cirrhotic cardiomyopathy may occur, including diastolic dysfunction, systolic dysfunction, and electrophysiological abnormalities. Although left ventricular systolic functions are normal at rest in cirrhosis patients, it may be impaired during stress. In this study, it was aimed to evaluate subclinical myocardial dysfunction in cirrhosis patients with 2D and 4D Strain. Twenty liver cirrhosis patients (13 females and 7 males) who were followed up in the gastroenterology outpatient clinic and referred to the Cardiology outpatient clinic for cardiac evaluation and 25 healthy individuals (9 females and 14 males) were included in the study. Standard echocardiographic measurements were made in all cases. Strain parameters were measured by speckle tracking method with 2D and 4D echocardiography. Cirrhosis patients in our study were not found to have systolic dysfunction by conventional method. The average EF value of the cirrhosis patient group with the conventional method was 65% and was within normal limits. The 2D GLS (p= 0.021) and 4D GPSL (p= 0.021) values were found to be significantly lower in cirrhosis patients compared to the control group. 4D Global Peak Strain Radial (GPSR) and Global Peak Strain Circumferential (GPSS) values were similar in the two groups. Although systolic functions as assessed by conventional echocardiography is normal in patients with cirrhosis, 2D GLS and 4D GPSL values are significantly lower than healthy controls and may be an indicator of subclinical LV systolic dysfunction. Myocardial dysfunction can be diagnosed at early stages in cirrhosis patients with 2D and 4D Strain evaluation.