Association of echocardiography-related parameters with the prognosis of decompensated cirrhosis: a retrospective cohort study

Cardiac morphology and function, which are conventionally evaluated by echocardiography, are often abnormal in decompensated cirrhosis. We aimed to evaluate the association of echocardiography-related parameters with prognosis in cirrhosis. This retrospective study included 104 decompensated cirrhotic patients, in whom cardiac structure and function were measured by echocardiography, including mitral inflow early diastolic velocity/mitral inflow late diastolic velocity (E/A), left atrium diameter, left ventricular end-diastolic dimension, interventricular septal thickness, left ventricular posterior wall thickness, right atrial transverse diameter, right atrial longitudinal diameter, right ventricular dimension (RVD), stroke volume, cardiac output, left ventricular ejection fraction, and fractional shortening. Cox regression and competing risk analyses and Kaplan-Meier and Nelson-Aalen cumulative risk curves were used to evaluate their associations with further decompensation and death in cirrhotic patients, if appropriate. Lower RVD was a predictor of further decompensation in Cox regression (adjusted by Child-Pugh score: <i>p</i> = 0.138; adjusted by MELD score: <i>p</i> = 0.034) and competing risk analyses (<i>p</i> = 0.003), and RVD ≤17 mm was significantly associated with higher cumulative incidence of further decompensation in Kaplan-Meier (<i>p</i> = 0.002) and Nelson-Aalen cumulative risk curves (<i>p</i> = 0.002). E/<i>A</i> ≤ 0.8 was a significant predictor of death in Cox regression (adjusted by Child-Pugh score: <i>p</i> = 0.041; adjusted by MELD score: <i>p</i> = 0.045) and competing risk analyses (<i>p</i> = 0.024), and E/<i>A</i> ≤ 0.8 was significantly associated with higher cumulative incidence of death in Kaplan-Meier (<i>p</i> = 0.023) and Nelson-Aalen cumulative risk curves (<i>p</i> = 0.024). Other echocardiography-related parameters were not significantly associated with further decompensation or death. RVD and E/A may be considered for the prognostic assessment of decompensated cirrhosis.

传统上通过超声心动图（echocardiography）评估的心脏形态与功能，在失代偿期肝硬化患者中常出现异常。本研究旨在探讨超声心动图相关参数与肝硬化患者预后的关联。本回顾性研究纳入104例失代偿期肝硬化患者，对所有患者采用超声心动图检测心脏结构与功能，检测指标包括二尖瓣舒张早期血流速度/二尖瓣舒张晚期血流速度（E/A）、左心房直径、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、右心房横径、右心房长径、右心室内径（RVD）、每搏输出量、心输出量、左心室射血分数及短轴缩短率。本研究根据情况采用Cox回归、竞争风险分析，以及卡普兰-迈耶（Kaplan-Meier）曲线与纳尔逊-艾伦（Nelson-Aalen）累积风险曲线，评估上述参数与肝硬化患者再次失代偿及死亡的关联。在Cox回归分析中，更低的RVD是再次失代偿的预测因素（经Child-Pugh评分校正：*p*=0.138；经MELD评分校正：*p*=0.034），且在竞争风险分析中亦得到验证（*p*=0.003）；RVD≤17mm与更高的再次失代偿累积发生率显著相关，该结果在卡普兰-迈耶曲线（*p*=0.002）与纳尔逊-艾伦累积风险曲线（*p*=0.002）中均得到证实。E/A≤0.8是死亡的显著预测因素，经Child-Pugh评分校正：*p*=0.041；经MELD评分校正：*p*=0.045，且在竞争风险分析中亦具有统计学意义（*p*=0.024）；E/A≤0.8与更高的死亡累积发生率显著相关，该结果在卡普兰-迈耶曲线（*p*=0.023）与纳尔逊-艾伦累积风险曲线（*p*=0.024）中均得到证实。其余超声心动图相关参数与再次失代偿或死亡均无显著关联。右心室内径（RVD）与E/A比值可用于失代偿期肝硬化的预后评估。