Right ventricular dysfunction in liver failure: a hemodynamic study

Introduction

Data investigating the clinical importance of right ventricular dysfunction (RVD) in liver disease are sparse. The use of a modified pulmonary artery catheter with a fast-response thermistor to assess the right ventricular ejection fraction (RVEF) and right ventricular end-diastolic-volume index (RVEDVI) can aid in the diagnosis of and guide appropriate therapy for RVD in critically ill patients. In a previous study, RVD was defined as RVEF < 52% and RVEDVI > 92 ml/m² [1]. We aimed to investigate the prevalence of RVD in a heterogeneous group of patients with multiorgan failure and liver disease admitted to a specialist liver ICU. In addition, differences in right ventricular function were compared in patients in acute liver failure (ALF) and with acutely decompensated chronic liver disease.

Methods

Over a 24-month period, hemodynamic data for 16 patients were analyzed. Patients with known significant tricuspid regurgitation and arrhythmias were excluded. Patients were grouped according to etiology into ALF and acute-on-chronic liver disease (AoCLD). Comparison of hemodynamic data was performed using Mann–Whitney U tests.

Results

See Table 1. All patients showed evidence of RVD, but the RVEDVI was higher in patients with AoCLD. The pulmonary artery occlusion pressure (PaOP) was not different between groups. The transpulmonary gradient (TPG = MPAP - PaOP) as a marker of increased pulmonary vascular resistance was higher in AoCLD patients despite similar pulmonary artery pressures.

Table 1 Results of hemodynamic parameters obtained from right heart catheterisation

Conclusion

RVD is common in patients with liver failure and is more severe in AoCLD patients. Whether treatment based on RVEF and RVEDVI monitoring in liver disease can improve patient outcome still needs to be proven.