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.

1. Pudil R, Pelouch R, Praus R, Vašatová M, Hulek P. Heart failure in patients with liver cirrhosis. Cor Et Vasa. 2013;55(4):e391-6.
2. Tangaroonsanti A, Ngernsritrakul T, Vanavanan S, Sobhonslidsuk A. The relationship between troponin I level and the severity of liver cirrhosis. Journal Of Gastroenterology And Hepatology 2012; 27:231
3. Pateron D, Beyne P, Laperche T, Logeard D, Lefilliatre P, Sogni, P et al. Elevated circulating cardiac troponin I in patients with cirrhosis. Hepatology. 1999; 29: 640–643
4. Pozzi M, Carugo S, Boari GI, Pecci V, de Ceglia SE, Maggiolini S et al. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. Hepatology. 1997;26(5):1131-7.
5. Al –Toma FJ, Dawood MS. Behavior of Creatine Kinase Isoenzymes in Hepatic Diseases. Kufa Med. Journal. 2008; 11(1): 501-7.
6. Florence WO, Samuel SI, Peter LI, BLENDIS LM. Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis?. Clinical Science. 2001;101(6): 621-8.
7. Licata A, Corrao S, Petta S, Genco C, Cardillo M, Calvaruso V,et al. NT pro BNP plasma level and atrial volume are linked to the severity of liver cirrhosis. PloS one. 2013;8(8):e68364.
8. Metwaly A, Khalik AA, Nasr FM, Sabry AI, Gouda MF, Hassan M. Brain Natriuretic Peptide in Liver Cirrhosis and Fatty Liver: Correlation with Cardiac Performance. Electronic Physician. 2016;8(2):1984-1993.
9. Wong F, Siu S, Liu P, Blendis LM. Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis? Clinical Science. 2001;101 (6) 621-628.
10. Fattouh AM, El-Shabrawi MH, Mahmoud EH, Ahmed WO. Evaluation of cardiac functions of cirrhotic children using serum brain natriuretic peptide and tissue Doppler imaging. Annals of Pediatric Cardiology. 2016;9(1):22-28.

Dr D.Udayashankar MD

Associate Professor, Department of General medicine, Chettinad Hospital and research institute,

Kelmbakkam, Kanchipuram district, Tamilnadu. 603103, Phone: 09710681751