Prevalence and clinical presentation of cirrhotic cardiomyopathy: A single centre experience from southern India

There are scanty data from India on the prevalence and clinical profile of cirrhotic cardiomyopathy (CCM).

To identify the prevalence and clinical presentation of CCM in patients with liver cirrhosis.

Five hundred and eighty-six patients with liver cirrhosis were recruited based on inclusion criteria and evaluated for cardiac parameters using electrocardiography, 2-dimensional echocardiography, dobutamine stress test and coronary angiography as needed. Baseline demographic data, liver biochemistry, endoscopic and radiological findings were recorded in all the patients. Appropriate statistical analyses were performed. 

Four thousand eight hundred and seventy-seven patients with liver disease were registered during the study period. Five hundred and eighty-six cirrhotic patients had cardiac evaluation as per the study protocol. One hundred fifty-nine had coronary artery disease and were excluded. One hundred and ninety-eight of 427 remaining patients (46.4%) had CCM. The median age of patients with CCM was higher compared with those without CCM (52 years vs. 46 years; p-value < 0.00001). Likewise, cirrhosis-related complications ([isolated or in combination], lower pulse rate [< 60/min] and prolonged corrected QT interval [QTc]; p<0.00001) were more frequent in patients with CCM. After excluding known risk factors for CCM such as alcohol, diabetes, hypothyroidism, hypertension, the true prevalence of CCM was 8.2% (48 out of 586). Hepatotropic viral infections (p 0.03) and prolonged QTc (p 0.0004) were commoner in CCM.

Prevalence of CCM in our setting is 33.8%. CCM is commoner in males and is independent of the etiology of cirrhosis, comorbidity and severity of liver disease. Diastolic dysfunction and prolonged QTc interval are common in CCM.