# Novel insights into cardiac structure, function, perfusion, and tissue characteristics in liver cirrhosis: a magnetic resonance analysis

## TL;DR

This study uses magnetic resonance imaging to show that liver cirrhosis causes changes in heart structure and function, including increased heart chamber sizes and signs of tissue damage.

## Contribution

The study provides novel CMR-based insights into cardiac changes in liver cirrhosis, including associations with disease severity.

## Key findings

- Liver cirrhosis patients had higher left and right ventricular ejection fractions compared to healthy controls.
- Non-ischemic late gadolinium enhancement was observed in 20% of cirrhosis patients.
- Disease severity scores correlated with increased extracellular volume and biventricular volumes.

## Abstract

This study analyzed the impact of liver cirrhosis on cardiac structure, function, tissue characteristics, and stress perfusion using cardiac magnetic resonance (CMR) imaging.

Fifty patients with liver cirrhosis and 25 matched, healthy controls received a 3-T CMR exam. Left and right ventricular (LV, RV) and atrial (LA, RA) volumes and functions were analyzed, including ejection fraction (EF), and feature tracking strain analysis. T1/T2 relaxation times and extracellular volume (ECV) were determined.

Patients with cirrhosis showed a higher LVEF (66.6 ± 5.8 vs. 59.6 ± 4.5%, p < 0.001) and RVEF (65.4 ± 6.5 vs. 55.7 ± 8.0%, p < 0.001). LV (86.1 ± 16.2 vs. 78.0 ± 14 mL/m2, p = 0.038) volumes were higher in patients (48.8 ± 15.5 vs. 33.2 ± 9.1 mL/mL/m2, p = 0.014). RV volumes were also higher, but not statistically significant (85.1 ± 17.6 vs. 78.7 ± 13.8 mL/m2, p = 0.116). LV (−20.1 ± 3.4 vs. −17.1 ± 2.1%, p < 0.001) and RV global longitudinal strain (−25.8 ± 5.5 vs. −21.2 ± 5.4%, p = 0.001) were enhanced, similar to LV radial/circumferential strain. The Child-Pugh class and the model of end-stage liver disease (MELD) score were associated with an increase in ECV of 4.8 [1.8 to 7.8]% (p = 0.003) and 0.5 [0.2 to 0.8]% (p < 0.001). MELD was also associated with end-diastolic volumes (0.9 [0.1 to 1.7] mL/m2, p = 0.030 for the LV and 1.0 [0.1 to 1.9] mL/m2, p = 0.029 for the RV). No patient showed a perfusion deficit, while 20% showed non-ischemic late gadolinium enhancement (LGE).

Liver cirrhosis patients showed cardiac dilatation and increased ventricular function compared to controls. Non-ischemic LGE was present in 20% of patients. Disease severity scores were linked to an increased ECV and biventricular volumes.

Question
The effect of liver cirrhosis on cardiac structure, function, perfusion, and tissue characteristics has not been sufficiently investigated using cardiac MR.

Findings
Subjects with liver cirrhosis showed cardiac dilation, increased biventricular function compared to controls, non-ischemic LGE, and an association between disease severity and the extracellular volume.

Clinical relevance
Liver cirrhosis results in cardiac changes characterized by MR, predominantly dilatation and hypercontractility, as well as signs of myocardial fibrosis and elevated extracellular volume with increasing disease severity.