Submitted: 06 Oct 2018
Accepted: 09 Jun 2019
ePublished: 22 Jun 2019
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J Cardiovasc Thorac Res. 2019;11(2): 127-131.
doi: 10.15171/jcvtr.2019.22
PMID: 31384407
PMCID: PMC6669429
  Abstract View: 461
  PDF Download: 329

Original Article

Reduced myocardial reserve in cirrhotic patients: an evaluation by dobutamine stress speckle tracking and tissue Doppler imaging (TDI) echocardiography

Mahmood Zamirian 1,2, Forough Afsharizadeh 1,3, Alireza Moaref 1,2, Firoozeh Abtahi 1,2, Fatemeh Amirmoezi 1, Armin Attar 1,2* ORCID logo

1 Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Students’ Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran


Introduction: Despite the normal systolic function at rest, cirrhotic patients often suffer from volume overload and symptoms of heart failure as they face stressful situations. This study investigated the myocardial reserve in cirrhotic patients at resting condition and peak stress by dobutamine speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI).
Methods: Twenty cirrhotic patients and 10 normal individuals aged 30-50 were selected randomly. For all of the participants, complete echocardiographic study of 2D, STE and TDI was done at rest and peak stress status with dobutamine. The following parameters were assessed: ejection fraction (EF), global longitudinal LV strain (GLS), strain rate in the septal basal segment and lateral wall and E’ in the septal basal segment by color-coded method.
Results: At baseline, EF was higher than 55% in both groups. GLS was higher (-22.6±2.4%) in the case group than the control group (-19.2±1.9%) at resting condition. After stress, it showed a greater increase (-22.5±1.7%) in the controls compared to cirrhotic patients (-22.6±3.3%; mean difference = 2.6 ± 2.03, P = 0.02). In cirrhotic patients, the average strain rate in the basal septal segment decreased after stress (-1.2 ± 0.3/s to-1.1 ± 0.3/s), but it increased in the control group (-1.1 ± 0.2/s to -1.8 ± 0.2/s).
Conclusion: Despite the presence of normal resting systolic function in cirrhotic patients, there was insufficient increase or even a decrease in myocardial function with stress; this may indicate the absence of sufficient myocardial reserve in cirrhotic patients. These findings would help to explain the reason for occurrence of heart failure or hemodynamic changes in cirrhotic patients.
Keywords: Cirrhosis, Global Strain, Myocardial Reserve, Speckle Tracking, Echocardiography
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