Central hemodynamic and exercise tolerance in women and men with liver cirrhosis

Introduction: It is well known that cardiovascular complications in liver cirrhosis are associated with cardiac dysfunction and changes of the central and peripheral hemodynamics. It has also been proven that exercise tolerance significantly decreases in liver cirrhosis along with the progression of the disease. So far, any significant differences weren’t found between women and men in the development of liver cirrhosis. The aim of the study was to conduct a comparative research on hemodynamic changes and exercise tolerance in liver cirrhosis in women and men. Methods: The study included 64 patients with HBV and HCV viral cirrhosis, Child-Pugh class B, 34 men and 30 women. Control group consisted of 60 healthy individuals, 33 men and 27 women. Using duplex Doppler echocardiography were determined left atrial (LA) diameter, left ventricular (LV) end-diastolic volume (EDV) and end-systolic volume (ESV), LV ejection fraction (EF), cardiac index (CI), the diameter of the right ventricle (RV), right atrial (RA) diameter, pulmonary flow acceleration time (PFAT) and systemic vascular resistance (SVR). Also there were assessed mean arterial pressure (MAP), heard rate (HR) and exercise tolerance measured in METs (metabolic equivalent). Results: Patients with liver cirrhosis compared with healthy subjects had significantly increased diameters of RA, RV, LA and CI. On the other hand, SVR was significantly decreased in hepatic cirrhosis compared with healthy individuals. No significant differences were detected in MAP, HR and echocardiographic parameters of central hemodynamics between men and women, both in patients with liver cirrhosis and between healthy women and healthy men. Exercise tolerance was significantly higher in healthy men compared to healthy women (11.3 ± 0.7 vs 9.2 ± 0.5 METs, p < 0.05), whereas in liver cirrhosis exercise tolerance was significantly lower in men compared to women (5.8 ± 0.4 vs 6.9 ± 0.5 METs, p <0.05). Conclusions: Cardiovascular changes occurring in liver cirrhosis are characterized by increased LA and right heart dimensions, increased cardiac output and decreased peripheral vascular resistance. Exercise tolerance in patients with liver cirrhosis is significantly decreased compared with healthy subjects. Although exercise tolerance in healthy individuals is higher in men, our study showed that in liver cirrhosis it is signifi cantly higher in women. The cause of this difference is not fully known, but it can be assumed that in cirrhosis asthenic syndrome and muscle atrophy are more expressed in men than in women.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)