Rational Pharmacotherapy in Cardiology

Advanced search

Remodeling of the Pulmonary Circulation in Patients with Viral Liver Cirrhosis

Full Text:


Aim. To study some structural and functional indicators of the right heart, as well as the effect of antiviral therapy on these parameters in patients with viral liver cirrhosis (VLC).

Material and methods. Patients with VLC (n=98; mean age 40.6 years, disease duration 3.9 years) were examined. The patients were divided into 2 groups: without ascites (1 st group; n=59) and with ascites (2nd group; n=39). The control group included 22 healthy volunteers. All participants had standard and tissue Doppler echocardiography.

Results. The thickness of the anterior wall of the right ventricle (RV) was increased in the 1 st and 2nd groups compared with the control (by 20% and 27%, respectively), as well as the volume index of the left atrium. The decrease in the rate of early RV filling (E) and the E/A ratio was found: in the 1st group - 0.9 [0.8;1.31 ], in the 2nd group - 0.8 [0.78; 1.2] with a control value of 1.6 [1.2;1.94] (p<0.001). Patients of the 2nd group compared with the control group and patients of the 1st group showed an increase in myocardial productivity index (by 35% and 35%, respectively) and time of isovolumetric RV filling (by 32% and 29%, respectively). RV dilatation, an increase in the index of the volume of the left atrium, dilatation of the pulmonary artery and an increase in systolic pressure in the pulmonary artery (in 2nd group - 36 [26;39] mm Hg, in 1 st group - 28 [1 9;32] mm Hg, in control - 24 [11 ;26] mm Hg; p<0.001) were also found in the 2nd group. The decrease in the maximum systolic velocity of the fibrous ring of the mitral valve in comparison with the reference level was found in 21 (36%) VLC patients with ascites and in 6 (1 6%) without ascites. The use of antiviral therapy led to a decrease in the left atrial volume index and systolic pressure in the pulmonary artery. A correlation was found between pressure level in the pulmonary artery and the Tei index (r=0.74; p<0.001), the systolic velocity of movement of the fibrous ring of the mitral valve (r=0.54; p<0.001), the diastolic velocity Em (r=0.72; p<0.001), blood flow velocity in the own liver artery (r=0.63; p<0.001) as well as the maximum systolic velocity in the portal vein (r=0.61; p<0.001).

Conclusion. Structural and functional changes in the right heart and left atrium were found in VLC patients. These disorders depend on the degree of decompensation of the hepatic process and are more pronounced in patients with ascites. Antiviral therapy had a positive effect on some morpho-functional parameters of the heart. The found correlations indicate the effect of hepatic-portal blood flow on cardiohemodynamic disorders.

About the Authors

M. V. Chistyakova
Chita State Medical Academy
Russian Federation

Marina V. Chistyakova - MD, PhD, Professor, Chair of Functional and Ultrasound Diagnostics.

Gorkogo ul., 39а, Chita, 672090

A. V. Govorin
Chita State Medical Academy
Russian Federation

Anatoly V. Govorin - MD, PhD, Professor, Head of the Chair of Faculty Therapy.

Gorkogo ul., 39а, Chita, 672090

Yu. V. Parkhomenko
Chita State Medical Academy
Russian Federation

Yuri V. Parkhomenko - MD, PhD, Professor, Chair of Therapy.

Gorkogo ul., 39а, Chita, 672090


1. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017 [cited by Apr 20, 2019]. Available from:

2. Westbrook R.H., Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61 (1 Suppl):S58-68. doi:10,1016/j.jhep.2014.07.012.

3. M0ller S., Henriksen J.H. Cardiovascular complications of cirrhosis. Gut. 2008;(57):268-78. doi:10.1136/gut.2006.112177.

4. Kalacheva TP,, Chernyavskaya G.M, Beloborodova Eh.I. et al. Disorders of vessel regulation function of endothelium and echocardiographic assessment of indicators of myocardial dysfunction and hemodynamics of the pulmonary circulation in liver cirrhosis. Kardiologiia. 2016;56(1):41-7 (In Russ.) doi:10.18565/cardio.2016.1.41-47.

5. Gurghean A .V,, Tudor I.A. Pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension. An echographic study Clujul Med. 2017; 90(2):161 -5. doi:10.15386/cjmed-705.

6. Sherman M., Shafran S., Burak K., et al. Management of chronic hepatitis C: consensus guidelines. Can J Gastroenterol. 2007;21 Suppl C:25C-34C.

7. McCaughan G.W., Omata M., Amarapurkar D., et al. Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection. J Gastro Enterol Hepatol. 2007;22(5):61 5-33. doi:10.1111/j.1440-1746.2007.04883.x.

8. . Yаgoda A.V., Shnyukova TV Cardiovascular aspects of the action of hepatotropic viruses in conditions of chronic infection. Medical Bulletin of the North Caucasus. 2007;2:27-33 (In Russ.)

9. Lin M.S., Chung C.M., Chang M.L., et al. The Unraveled Link Between Antiviral Therapy and Heart Failure Hospitalization in Chronic Hepatitis C Virus Infection - A Nationwide Cohort Study. Circ J. 2018;82(6):1 623-31. doi:10.1253/circj.CJ-17-1118.

10. Ilyas S.Z., Tabassum R., Hamed H., et al. Hepatitis C Virus-Associated Extrahepatic Manifestations in Lung and Heart and Antiviral Therapy-Related Cardiopulmonary Toxicity. Viral Immunol. 2017;30(9):633-641. doi:10.1089/vim.2017.0009.

11. Teske A.J., De Boeck B.W., Olimulder M., et al. Ehocardiographic assessment of regional right ventricular function: a head-to-head comparison between 2-dimensional and tissue Doppler-derived strain analysis. J Am Soc Echocardiogr. 2008;21(3):275-83. doi:10.1016/j.echo.2007.08.027.

12. Geyer H., Caracciolo G., Abe H. et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 2010;23(4):351 -69. doi:10.1016/j.echo.2010.02.015.

For citation:

Chistyakova M.V., Govorin A.V., Parkhomenko Yu.V. Remodeling of the Pulmonary Circulation in Patients with Viral Liver Cirrhosis. Rational Pharmacotherapy in Cardiology. 2019;15(2):204-208. (In Russ.)

Views: 403

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)