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A study carried out by Unimore and the Modena General Hospital shows the relation existing among cardiac dysfunction, inflammation and prognosis of cirrhosis

A research study carried out by the Gastroenterology Department of the University Hospital of Modena, directed by professor Erica Villa of Unimore, showed the importance of the dynamic status of the heart (the so called cardiac output) at rest and of high values of the circulating C-reactive protein as indicators of prognosis for liver cirrhosis.

The research was coordinated by doctor Filippo Schepis of Unimore, responsible for the Laboratory of Liver Hemodynamics, and was published on the May 2018 issue of Journal of Hepatology, one of the most important scientific magazines in the sector. For this study, 238 patients had been enrolled at the General Hospital between 2013 and 2015.

The study also saw the participation of Laura Turco and Marcello Bianchini (both also working at the Laboratory of Liver Hemodynamics of the Gastroenterology Department), the interventionist radiologists Cristian Caporali and Stefano Colopi (now in Mantua), and professor Rosario Rossi of the Cardiology Department of the Modena General Hospital.

There are two main studies of liver cirrhosis in the phase when it is associated with a high pressure in the venous system taking the blood to the liver (editor’s note: a condition defined as portal hypertension and representing the cause of the main clinical signs of cirrhosis) – doctor Filippo Schepis explained – the first one known as the compensation stage, the second one known as decompensation stage. During the compensation stage, the main risk is decompensating and developing the ascites, namely an accumulation of fluid in the peritoneal cavity. Once the patient is decompensated, the main risk is death in 2-5 years time, unless he/she is subject to liver transplantation. Our study proved that physiopathological processes leading to the development of ascites and to the patient’s death involve the heart, reducing its capacity to adapt to the requests for an increased workload imposed by the same liver insufficiency and portal hypertension. In addition, patients with cirrhosis and portal hypertension suffer from an inflammatory status of the whole body, which gets worse as the illness progresses and varies according to the continuous flow of bowel bacteria in the blood circulation”.

The existence of a cardiac output exceeding the maximum standard threshold (hyper dynamic circulation) or not reaching the average values (relatively hypo dynamic circulation), together with high values of circulating reactive C protein (as indication of the inflammatory status of the body) allow doctors to identify the patients with the highest risk of decompensation or death.

Professor Erica Villa added that “This means that in patients with cirrhosis both the cardiac dysfunction and the systemic inflammatory status can be measured, and therefore their reversibility may be assessed depending on possible specific treatments”. In fact, the study provides risk values (cut-off) of both the cardiac output and the reactive C protein. This will allow for its application to validation studies and clinical practice of the parameters detected, for the purposes of both improving the categorisation of the risk in patients, and monitoring the effects of existing or future therapies aimed at curbing the systemic inflammatory status and cardiac dysfunction in patients with cirrhosis and portal hypertension. 

The Laboratory of Cardiac Hemodynamics, directed by professor Rosario Rossi, and the Department of Interventionist Radiology, directed by professor Pietro Torricelli, also participated in this study.

Professor Rosario Rossi added that “Since the Laboratory of Liver Hemodynamics of Gastroenterology was established, the four-handed treatment (those of the cardiac hemodynamist and the liver hemodynamist) has become quite frequent for the complete hemodynamics study of the heart (right and left cardiac catheterization, coronarography) and the liver (HVPG measurement and transjugular needle biopsy) in the same procedure. This ensures the minimum stress for the patient and the maximum integration of competencies, which is now possible in clinical practice for the characterisation of both the cardiac dysfunction in patients with cirrhosis and portal hypertension, and other cardiac pathologies (such as the ischaemic one) that are increasingly associated with liver cirrhosis not caused by viruses”. 

“The recently published study - finally added professor Pietro Torricelli – also included patients who are eligible for the transjugular insertion of a portal and systemic shunt (TIPS) for the treatment of ascites that is immune to the treatment with diuretics. Since 2010, at the General Hospital of Modena, this interventionist radiology procedure is being carried out in close cooperation with the hepatology and hemodynamics specialists, specifically aimed at carefully monitoring the effects on the liver and the heart of the shunt opening and closing, and implementing the best therapy supporting the cardiac function in the immediate post-surgery in patients with the highest risk of death according to the recently published study”.

Categorie: International - english

Articolo pubblicato da: Ufficio Stampa Unimore - ufficiostampa@unimore.it