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KMID : 1103920100160040376
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Korean Journal of Hepatology
2010 Volume.16 No. 4 p.376 ~ p.382
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Dobutamine stress echocardiography for evaluating cirrhotic cardiomyopathy in liver cirrhosis
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Kim Moon-Young
Baik Soon-Koo
Won Chan-Sik
Park Hong-Jun
Jeon Hyo-Keun
Hong Hyun-Il
Kim Jae-Woo
Kim Hyun-Soo
Kwon Sang-Ok
Kim Jang-Young
Yoo Byung-Su
Lee Seung-Hwan
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Abstract
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Background/Aims: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE).
Methods: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured.
Results: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed.
Conclusions: Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
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KEYWORD
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Cirrhotic cardiomyopathy, Dobutamine stress echocardiography, Liver cirrhosis
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