Usage of tissue doppler, tei index and pulse doppler for comparison with control group at evaluation of cardiac morphology and function of cirrhotic patients

Cirrhotic cardiomyopathy (CCMP) is characterized by impaired diastolic relaxation together with contactil response blunt to stress and/or electrophysiological abnormalities with absence of other known cardiac diseases. Recently most CCMP diagnoses are missed because transthoracic echocardiography (TTE) is performed during rest. In order to diagnose before terminal stage, we can catch overlooked CCMP cases by some echocardiogarphic parameters. With this study, we aimed to diagnose CCMP at early stage before the development of systolic heart failure by using myocardial performance index (MPI) and tissue Doppler parameters at cirrhotic patients. Twenty nonalcoholic cirrhotic patients with a cirrhosis followup time longer than 6 months and 20 healthy age-and sex-matched volunteers as the control group were enrolled to the study. When demographical and clinical data of 20 patients and 20 volunteers enrolled to the study were examined, there were no significant differences between groups. As expected, liver function tests and INR values were higher at the patient group compared to control group, but surprisingly uric acid level was higher at the patient grorup compared to control group (p:0.002). When echocardiographic data were examined, mean left atrial diameters were found to be greater at patient group (p< 0.001). Among diastolic disfunction data, there was no significant difference between E/A, where mitral deceleration time was longer at the patient group (p: 0.001). MPI calculated from Doppler time intervals and mean MPI calculated from tissue Doppler were significantly higher at the patient group compared to control group (p<0.001). Mean septal and lateral annulus systolic velocities detected by tissue Doppler were lower at the patient group (p<0.001). Conclusively, CCMP courses subclinically as left ventricule afterload decreases due to peripheral vasodilatation. For this reason, it?s highly likely that it?s missed by conventional TTE. As presented at our study, it?s possible to detect CCMP cases bu using MPI and tissue Doppler screening methods. Thus, clinical deterioration such as pulmonary edema risk under stressful conditions at cirrhotic patients can be prevented and necessary precautions can be taken. For this reason, especially if an approach which may affect hemodynamics of a cirrhotic patient is being planned, detailed evaluation with MPI and tissue Doppler besided conventional TTE should be performed