Mehmet Öncül, Şükrü Güngör, Özlem Elkıran, Fatma İlknur Varol, Emre Gök, Fatih Tat, Hanım Bayram, Selçuk Erdoğan, Elif Damar Güngör, Yurday Öncül
Hyperdynamic circulation appears to mask resting systolic metrics in pediatric cirrhosis. However, prolonged diastolic phases and increased MPI suggest presence of subclinical myocardial dysfunction, especially during clinical decompensation. Routine non-invasive liver staging scores show potential clinical utility as ancillary screening tools for early cardiovascular risk evaluation.
OBJECTIVE: This prospective study evaluated systolic and diastolic cardiac functions in pediatric cirrhosis using conventional and tissue Doppler imaging (TDI), and explored their correlation with liver severity scores.
METHODS: Conducted at Inonu University, we enrolled 75 pediatric cirrhotic patients (44 compensated, 31 decompensated) from Pediatric Gastroenterology and 61 controls of similar age and sex without structural/functional heart disease from Pediatric Cardiology outpatients. All underwent clinical, laboratory, and echocardiographic assessments. To address multiple testing, Bonferroni correction was applied. Adjustments for age, sex, and disease severity were integrated into the correlation matrices to control for confounding parameters.
RESULTS: The cirrhosis cohort exhibited significantly higher heart rates, ejection fractions, and aortic/pulmonary velocity-time integrals than controls (p < 0.05). Conversely, growth-independent diastolic indices revealed distinct relaxation impairment: transmitral E/A and annular e'/a' ratios were significantly lower, while Mitral E/e' was elevated (p < 0.05). Deceleration time, isovolumetric relaxation time, and Myocardial Performance Index (MPI) were significantly prolonged (p < 0.01). Decompensated patients demonstrated significantly higher left ventricular filling pressures (Mitral E/e') than compensated patients and controls (p = 0.002). After adjusting for age and sex, the Pediatric End-Stage Liver Disease (PELD) score maintained significant positive correlations with heart rate (r = 0.408) and Mitral E/e' (r = 0.433) (p ≤ 0.002). FIB-4 and APRI scores showed positive correlations with VTI and TAPSE, markers of right ventricular volume overload (p < 0.05).
CONCLUSIONS: Hyperdynamic circulation appears to mask resting systolic metrics in pediatric cirrhosis. However, prolonged diastolic phases and increased MPI suggest presence of subclinical myocardial dysfunction, especially during clinical decompensation. Routine non-invasive liver staging scores show potential clinical utility as ancillary screening tools for early cardiovascular risk evaluation.