Evaluation of cardiac and respiratory status in cirrhotic patients

Gürbüz B. Evaluation of Cardiac And Respiratory Status in Cirrhotic Patients Hacettepe University Faculty of Medicine, Thesis in Internal Medicine; Ankara, 2023. Liver cirrhosis is a multisystemic disease with significant complications. Cardiac and respiratory systems are also affected in liver cirrhosis. Detailed examination of respiratory symptoms, pulmonary and cardiac complications of cirrhotic patients may be effective in determining prognosis and improving patients' quality of life. In this study, our aim was to determine the respiratory symptoms and cardiac status of cirrhotic patients and to evaluate the relationship with exertional capacity and to examine its effect in determining the prognosis of cirrhosis. In this study, 75 patients followed up with the diagnosis of cirrhosis were included, and spirometry, 6-minute walking test, electrocardiography and transthoracic echocardiography were performed. Hospitalizations, decompensation and death status of the patients were recorded during the 9 months of the study. Accordingly, decompensated patients had significantly more dyspnea (p<0.001), exertional dyspnea (p:0.001), orthopnea symptoms (p<0.001). mMRC (modified Medical Research Council) scale (p:<0. 001) were significantly higher, FEV1% (p:0.003), FVC% (p<0.001) were significantly lower, 6-minute walk distance was 14% shorter than expected (p:0.001) in decompensated patients. Hepatic hydrothorax was found in 3 patients. Patients with FEV1<70% on spirometry were defined as restrictive, and patients with restrictive results had a mean 6-minute walk distance 173 meters lower (p<0.001). Data of patients who could not complete the 6-minute walk test due to symptoms were analyzed separately. Regression analysis of mortality showed that failure to complete the 6-minute walk test increased the risk of mortality 31-fold (OR: 31.00 [95% CI; 3.07-312.83], p:0.004). Patients were evaluated for cirrhotic cardiomyopathy by cardiologic examination, electrocardiography and transthoracic echocardiography. Accordingly, cirrhotic cardiomyopathy was detected in 29 patients (38.7%) based on the systolic and diastolic dysfunction criteria of the World Gastroenterology Congress Cirrhotic Cardiomyopathy Criteria and in 3 patients (4%) when the 2020 Cirrhotic Cardiomyopathy Consortium Cirrhotic Cardiomyopathy Criteria were applied. This difference suggests that a criterion for cirrhotic cardiomyopathy that can be easily applied in routine practice and includes universally valid parameters has not yet been developed. In conclusion, respiratory and cardiac complications of cirrhosis that may be missed in patients should be evaluated. 6-minute walk test, which can be considered as a cardiopulmonary exercise test, was found to be a significant guide in the prognosis and mortality of cirrhosis.