부산대학교 도서관

Background: Liver cirrhosis (LC) is associated with an increased risk of cardiovascular disease (e.g. cirrhotic cardiomyopathy). Coronary flow reserve (CFR) is widely used to examine the integrity of coronary microvascular circulation. We evaluated the prevalence of impaired CFR in patients with advanced LC, awaiting liver transplantation, and the relationship between CFR and nervous autonomic function.Methods: Twenty consecutive patients with advanced LC (16 M, aged 57 ± 11) without clinical evidence of heart disease, and 46 age- and gender-matched controls were evaluated. Coronary flow velocity in the left anterior descending coronary artery was detected by transthoracic Doppler harmonic echocardiography at rest and during adenosine infusion. CFR was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. CFR≤2.5 was considered abnormal and patients with abnormal CFR underwent to coronary multidetector computed tomography (MDCT) in order to exclude an epicardial coronary stenosis. The nervous autonomic function was evaluated by Heart Rate Variability (HRV), through a 12-lead Holter ECG in all patients.Results: Coronary flow reserve was significantly lower in patients with LC than in controls (2.7±0.9 vs 3.7 ± 0.6, p<0.001). An impaired CFR (i.e. ≤2.5) was found in 8 LC patients (40%) whereas all controls had normal CFR values (p<0.001). MSCT was normal in all patients with CFR≤2.5. Heart Rate Variability analysis showed a severe reduction in heart rate variability, assessed Kleigerʼs index (SDNN), in patients with CFR> 2.5 and an increase in this index in subjects with CFR <2.5 (p<0.04).Conclusions: Our findings indicate that in patients with advanced liver cirrhosis: (a) an abnormal CFR is found in approximately 40% of cases, and (b) loss of sympathetic tone seems to be a predictor of depressed CFR. Coronary microvascular dysfunction might contribute to the development of cirrhotic cardiomyopathy.