The relationship between etiology and grade of disease diastolic dysfunction and brain natriuretic peptid (BNP) in liver cirrhosis

Introduction and Aim: Left ventricular diastolic dysfunction (LVDD) among the 3 criteria of cardiomyopathy is an early indication of cardiac dysfunction in patients with cirrhosis. Tissue doppler imaging echocardiography (TDI) is the most valuable method in the evaluation of LVDD. The aim of this study was to investigate the etiology and grade parameters of cirrhosis and the relationship between TDI results and brain natriuretic peptide. Material and Methods: The study included 100 patients with liver cirrhosis and 65 healthy controls. Demographic, etiological, clinical and laboratory results were obtained from the patients files as retrospectively. Child-Pugh and MELD-Na (Model for end-stage liver disease)scores were calculated. TDI findings and the relationship between BNP and the etiology and grade of the disease were assessed. Results: BNP level was in normal range in 76 patients (76%) and higher than normal range in 24 (24%) patients LVDD was not found in 65 (65%) of the patients and LVDD was found in 35 (35%) patients. There was no relationship between etiology and BNP level and LVDD. BNP level was 59.9 ± 75.6 in Child A patients, 84.0 ± 62.4 in Child B patients and 103.5 ± 57.1 in Child C patients (p = 0.001). BNP was higher than normal range in 14% of the Child A group, in 29.6% of the Child B group and in 50% of the Child C group (p=0.009). Child score was 6.5 ± 2 in patients with normal range (0-100 ng/L) BNP level and was 8.4 ± 2.7 in patients with higher (> 100 ng/L) than normal range BNP levels (p = 0.000). In patients with MELD score ≤ 9 é septal (early diastolic velocity of septal mitral annulus) 7.67 ± 1.71 cm/s, in those between 10-19 8.42 ± 1.79, in those 20-29, 5.00 ± 2.45 were found (p = 0.002) and é lateral (early diastolic velocity of lateral mitral annulus) was 11.3 ± 3.18 cm/s, 12.62 ± 2.89, 10.00 ± 3.06 (p = 0.01). LVDD was found in 37.2% of patients with MELD score ≤ 9, 26% of patients between 10-19 and 85.7% of those between 20-29 (p = 0.007). MELD score was 10.6 ± 3.2 in patients without LVDD and was 12.5 ± 5.8 in patients with LVDD (p = 0.048). Creatinine level was higher in patients with LVDD (0.9 ± 0.5 mg/dl) than in patients without LVDD statistically (0.8 ± 0.3 mg/dl) (p = 0.042) Conclusion: LVDD is highly prevalent in cirrhotic patients with a MELD score ≥ 20. BNP level is higher in cirrhotic patients than healthy people and increased in liver cirrhosis patients with ascites and high Child-Pugh scores. TDI findings and BNP levels may be important for early diagnosis and treatment of cardiac complications in patients with high-grade cirrhosis. Key words: Cirrhosis, Child, MELD, Diastolic dysfunction, Tissue doppler imaging echocardiography, BNP