Abstract

Introduction: Cirrhosis is well known to be associated with severe hemodynamic changes like hyperdynamic circulation, increased cardiac output, increased heart rate and decreased systemic vascular resistance resulting in cirrhotic cardiomyopathy (CCM). Patient with CCM are at higher risk for complications during surgeries and liver transplantation. Hence early detection may be beneficial in offering treatment even in patients asymptomatic for heart disease.

Objectives: To determine the presence of elevated cardiac biomarkers in patients with chronic liver disease and to study the relationship between these cardiac biomarkers and severity of chronic liver disease.

Methods: Cross sectional study including 50 adult patients diagnosed with chronic liver disease. Patients were subjected to detailed history and physical examination, basic biochemical profile, and cardiac biomarkers (Troponin I, CK MB, BNP). Severity of liver disease was assessed using Child-Pugh and MELD scores. The levels of cardiac markers in the study population, and their correlation with disease severity were evaluated using appropriate statistical methods.

Results: In the present study of 50 patients with chronic liver disease (CLD) the mean age was 46.48 years and 84%were male. 68% had alcohol related CLD, and 4% had chronic Hepatitis B. Troponin I was elevated in 12(24%) patients, CKMB in 46(92%) and BNP in 20(40%) patients. The elevation in cardiac enzymes demonstrated a linear correlation with severity of liver disease, Troponin I correlated significantly with Child Pugh score (p= 0.001) and Meld score(p=0.015); BNP with Child Pugh score(p=0.001) and MELD score(p=0.022). There was no statistically significant relationship between CKMB and severity of liver disease.

Conclusion: Troponin I may prove to be an useful marker of myocardial injury in chronic liver disease patients and elevated BNP may reflect an underlying cardiac dysfunction. Use of these biomarkers for screening patients with advanced liver disease may aid in early detection of cirrhotic cardiomyopathy.