BACKGROUND AND AIMS: The temporal relationship between cirrhotic cardiomyopathy, progression of liver disease, and survival remains unknown. Our aim was to investigate the development of structural and functional cardiac changes over time with the progression of cirrhosis and outcome.

METHODS: Sixty-three cirrhotic outpatients (Child class: A=9, B=46, C=8) and 14 healthy controls were included in this 2-year longitudinal study. Advanced cardiac characteristics such as cardiac MRI with extracellular volume (ECV) quantification, speckle tracking echocardiography, and biomarkers were assessed at 0/6/12/18/24 months. Patients were followed-up for a median of 30 months with registration of acute decompensations (AD), liver transplantation (LT), and death.

RESULTS: Patients who progressed, underwent LT, or died had more pronounced cardiac dysfunction with structural myocardial changes, and left atrial enlargement. Conversely, limited cardiac deterioration was seen in patients who remained stable or improved in cirrhosis. During follow-up 25 patients developed AD, 4 underwent LT, and 20 died. Mean arterial pressure was the only cardiovascular parameter associated with death in a univariate analysis (P=0.037), and the main predictors were MELD and age. However, last visit myocardial ECV was independently associated with the combined endpoint of LT/death (P=0.001), and in AD patients a low cardiac index was independently associated with death (P=0.01).

CONCLUSIONS: Cardiac function seems to deteriorate with the progression of cirrhosis and affects prognosis, especially in patients with AD. Conversely, patients with stable cirrhosis have limited progression in cardiac dysfunction over a 2-year period with modest impact on survival. The results encourage careful cardiac monitoring in advanced cirrhosis.