Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue Doppler imaging

Background : Cirrhotic cardiomyopathy (CCM) is described as the presence of cardiac dysfunction in cirrhotic patients. In children with chronic liver disease, CCM has been very rarely investigated. The Aim of the Study : Is to evaluate the cardiac function of cirrhotic children to identify those with CCM. Patients and Methods : Fifty-two cirrhotic patients and 53 age and sex matched controls were assessed using serum brain-type natriuretic peptide (BNP), conventional echocardiography, and tissue Doppler imaging. Results : Patients' mean ages were 7.66 +/- 4.16 years (vs. 6.88 +/- 3.04 years for the controls). The study included 27 males and 25 females (28 and 25 respectively for the controls). Patients had larger left atrium and right ventricle (RV) (P value 0.05) and increased LV posterior wall thickness than controls (P value 0.04). They had higher late atrial diastolic filling velocity (A) of tricuspid valve (TV) inflow (0.59 +/- 0.17 vs. 0.5 +/- 0.1 m/s, P < 0.001) and lower ratios between the early diastolic filling velocity (E) and A wave velocity (E/A) of both mitral valve and TV inflow (1.7 +/- 0.35 vs. 1.87 +/- 0.34 and 1.3 +/- 0.3 vs. 1.5 +/- 0.3, P < 0.005 and 0.0008, respectively). Patients had significantly longer isovolumic relaxation time of LV (45.5 +/- 11.1 vs. 40.5 +/- 7.7 ms P 0.008), higher late diastolic peak myocardial velocity (A') (11.8 +/- 3.6 vs. 9.5 +/- 2.7 ms, P 0.0003) and systolic velocity (S') of the RV (14.5 +/- 2.7 vs. 13.2 +/- 2.9, P 0.01) and significantly higher myocardial performance index of both LV and RV (P 0.001 and 0.01). BNP levels were significantly higher in cases than controls (5.25 ng/l vs. 3.75 ng/l, P < 0.04) and was correlated with the E wave velocity of the TV (r 0.004) and the E/E' ratio of the RV (r 0.001). None of the clinical or laboratory data were correlated with the BNP level. Conclusion : Cirrhotic children have cardiac dysfunction mainly in the form of diastolic dysfunction. There is a need that CCM be more accurately described in children.