Impact of diastolic dysfunction on exercise capacity in patients with liver cirrhosis

Background: Liver cirrhosis may cause left ventricular diastolic dysfunction (LVDD). It is not known if this has an impact on physical capacity. Aims: We aimed to evaluate the prevalence of LVDD and its impact on physical capacity in a prospective cohort of patients with cirrhosis of all Child-Pugh (CP) stages. Methods: Patients were enrolled between 2011 and 2016. Cardiopulmonary exercise testing-derived peak VO2, 6min walk test (6MWT), echocardiography, laboratory testing and lung function testing were performed. Patients with LVEF<50%, coronary artery disease, uncontrolled systemic hypertension, recent pulmonary embolism and significant pulmonary comorbidities were excluded. We assessed the prevalence of LVDD based on ECAVI guidelines 2016 and analyzed its impact on peakVO2 and 6MWT. Results: In our 197 patients (male N=146, age 56±10yrs, CPA N=92, CPB N=80, CPC N=25) peakVO2 was 71%(57-92) in CPA, 50%(40-60) in CPB and 42%(35-54) in CPC, p<0.001. CP score was significantly correlated with peakVO2 (rs=-0.512, p<0.001), 6MWT (rs=-0.467, p<0.001) and NTproBNP (rs=0.456, p<0.001). N=84(43%) had no LVDD, N=16(8%) LVDD°I, N=36(18%) LVDD°II, no patient had LVDD°III and N=61(31%) could not be classified. LVDD was more prevalent in advanced cirrhosis (CPA:39%, CPB:26%, CPC:75%, p=0.002). NTproBNP was significantly correlated with peakVO2 (rs=-0.370, p<0.001) and 6MWT (rs=-0.454, p<0.001), whereas e’ and E/e’ were not. There was no significant difference in physical capacity between patients with and without LVDD. Conclusions: Advanced LVDD is a rare finding in patients with cirrhosis. Although the biomarker of cardiac strain (NTproBNP) is significantly correlated with physical capacity, the presence of LVDD is not.