You may not know it, but liver cirrhosis may cause small but definite changes in your heart that are not considered normal. Nonetheless, a team of doctors who examined these cardiac changes say people who undergo liver transplants for cirrhosis wind up seeing these changes in the heart disappear.1
Liver cirrhosis involves the formation of scar tissue that replaces healthy liver tissue, and thus blocks blood flow through the organ, resulting in liver dysfunction. Chronic hepatitis B, C and D are common causes, as well as alcoholic liver disease and nonalcoholic steatohepatitis (NASH).2
Measuring Cirrhosis-Related Heart Changes
The relative changes in the heart related to cirrhosis is known as cirrhotic cardiomyopathy (sir-AH-tik car-dee-oh-my-AH-puh-thee), say doctors at Universitat Autonoma de Barcelona in Spain, who initiated the study. Physicians who've examined patients with such a condition, they say, have witnessed changes in the size of the ventricular wall, as well as both systolic and diastolic dysfunction,. (The term systolic refers to the heart's contracted state, and diastolic refers to the heart's resting state.)
The changes, explained Joan Genesca, MD, and her fellow researchers, occur in relation to portal hypertension—the high blood pressure that occurs in the vessels that carry blood to the liver due to cirrhotic scarring, which makes it difficult for blood to flow through the organ. These abnormal changes were the focus of this small study. "This is the first to evaluate the effects of liver transplantation on cirrhotic cardiomyopathy," Genesca said, in an interview.
Examining the Heart and Liver Transplant Effects
Using visual aids like echocardiography, Genesca and her team studied the changes in the heart in a group of 40 patients with liver cirrhosis. The findings were compared to results found in a group of 15 patients without cirrhosis or other liver diseases.
Using echocardiography, the team of researchers found that those patients with cirrhosis had abnormally active hearts, such as more heartbeats per minute. They also found a greater thickness in the ventricles (one of the pumping chambers of the heart) in the cirrhotic patients compared to those without cirrhosis, though the difference was "mild".
Patients in the group with cirrhosis were classified further as those with ascites and those without the condition. People with ascites had more diastolic dysfunction at rest compared to those without ascites, Genesca's group wrote.
"In response to physical stress, cirrhotic patients responded differently from controls," they wrote. Those with cirrhosis had "insufficient" increases in their heart rate and other measures of cardiac function.
The study researchers also evaluated 15 patients with cirrhosis between 6 months and 1 year after liver transplant to determine if the procedure reversed the abnormal changes in their hearts. "When data obtained from patients before and after liver transplantation were compared, striking differences were observed," Gensca's group wrote.
Echocardiography results showed "a significant improvement" in certain measures of heart function, such as heart rate after the transplant procedure. Ventricular wall thickness decreased, as well as other measures. "The response to physical stress was also greatly improved during the post-transplant period as compared to the pretransplant situation," they wrote. Significant improvements were found in various responses of the heart to stress.
In fact, when Genesca and her colleagues compared the 15 patients who underwent transplant to those in the group of healthy individuals, they found no significant differences in heart function between the two groups.
"This study demonstrates that cirrhotic patients, independently of the [cause] of cirrhosis, show a mild degree of increased ventricular wall thickness, a diastolic dysfunction that worsens with the presence of ascites and with physical stress, and insufficient and abnormal systolic response to stress," the researchers wrote. "The study also proves that these alterations are completely reversible after liver transplantation."
Patient Prognosis: Unanswered Questions
Despite these apparent changes in the heart, no consequences to the patient are likely, Genesca and her group advised. "From that point of view," they wrote, "no special recommendations should be made and routine screening for these abnormalities is not advised." But she also acknowledges that the long-term prognosis of patients with the condition who don't undergo liver transplantation isn't really known.
Based on other research, Genesca's group theorizes that cirrhotic cardiomyopathy combined with heart failure caused by bacterial or intestinal toxins "could contribute to further deterioration of [kidney] function in spontaneous bacterial peritonitis or hepatorenal failure [kidney failure related to liver disease]." The role of cardiac function in spontaneous bacterial peritonitis is the focus of a follow-up study that Genesca and her colleagues plan to begin soon, she said. Spontaneous bacterial peritonitis is acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and surrounds internal organs. It is common in people with ascites and/or cirrhosis.
1. Torregrosa M, Aguade S, Dos L et al. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol 2005 Jan;42(1):68-74.
2. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health (NIH). Cirrhosis of the Liver. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/index.htm. Accessed January 19, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
