Association of N- terminal pro brain natriuretic peptide with echocardiographic measures of diastolic dysfunction in cirrhosis


1 Department of Medicine, JIPMER, Puducherry, India

2 Department of Biochemistry, JIPMER, Puducherry, India

3 Department of Cardiology, JIPMER, Puducherry, India


Background: Liver cirrhosis is associated with cardiac dysfunction in 40%–60% of the patients. Serum NT-ProBNP is a potential additional marker of cirrhotic cardiomyopathy. Materials and Methods: It was a cross-sectional analytical study done in a tertiary care center in South India on 100 patients of cirrhosis of liver. Diastolic function was assessed from mitral inflow parameters as well as tissue Doppler imaging of the left ventricle in 95 patients. Serum NT-ProBNP levels was measured once at the time of inclusion into the study. Cirrhotic cardiomyopathy was diagnosed in those with abnormal echocardiographic parameters and its association with NT-Pro BNP levels was analyzed. Data were analyzed using SPSS version 22. Results: Diastolic dysfunction was found in 40 (42.1%) participants. Twenty-two (23.2%) had Grade I, 16 (16.8%) had Grade II, and 2 (2.1%) had Grade III diastolic dysfunction. The mean NT-Pro-BNP was elevated (107.38 [±66.76] ng/ml) in patients with diastolic dysfunction. NT-ProBNP was higher in Child–Pugh B and C disease when compared to milder disease. NT-ProBNP was not a good screening tool for cardiomyopathy in cirrhotic patients. Area under the curve was 0.517 with 95% confidence interval and the P = 0.77. However, positive correlation was present between the NT-ProBNP value and two echocardiographic parameters of diastolic dysfunction (E/A, E/E'). Conclusion: Increased serum NT-ProBNP levels in cirrhosis of liver have a positive correlation with echocardiographic measures of diastolic dysfunction of the heart but it is not a good tool for screening for cirrhotic cardiomyopathy.


Izzy M, VanWagner LB, Lin G, Altieri M, Findlay JY, Oh JK, et al. Redefining cirrhotic cardiomyopathy for the modern era. Hepatology 2020;71:334-45.  Back to cited text no. 1
Bokarvadia R, Jain M, Varghese J. Venkataraman Cirrhotic cardiomyopathy- Survival at 3 months after liver transplantation. Indian J Transplant 2019;13:91-5.  Back to cited text no. 2
  [Full text]  
Mocan M, Mocan Hognogi LD, Anton FP, Chiorescu RM, Goidescu CM, Stoia MA, et al. Biomarkers of inflammation in left ventricular diastolic dysfunction. Dis Markers 2019;2019:7583690.  Back to cited text no. 3
Shaikh S, Abro M, Qazi I, Yousfani A. Frequency of cirrhotic cardiomyopathy in patients with cirrhosis of liver: A tertiary care hospital experience. Pak J Med Sci 2011;27:744-8.  Back to cited text no. 4
Mahant S, Chandel N, Upasana, Mahant PD, Kumbhakar T. Cirrhotic cardiomyopathy – A significant complication of chronic liver disease patients. IOSR JDMS 2014;13:35-8.  Back to cited text no. 5
Dadhich S, Goswami A, Jain VK, Gahlot A, Kulamarva G, Bhargava N. Cardiac dysfunction in cirrhotic portal hypertension with or without ascites. Ann Gastroenterol 2014;27:244-9.  Back to cited text no. 6
Belay T, Gress T, Sayyed R. Cirrhotic cardiomyopathy among patients with liver cirrhosis. Open J Gastroenterol 2013;3:344-8.  Back to cited text no. 7
Salari A, Shafaghi A, Ofoghi M, Saeidinia A, Mansour-Ghanaei F. Diastolic dysfunction and severity of cirrhosis in nonalcoholic cirrhotic patients. Int J Hepatol 2013;2013:892876.  Back to cited text no. 8
Zuberi BF, Ahmed S, Faisal N, Afsar S, Memon AR, Baloch I, et al. Comparison of heart rate and QTc duration in patients of cirrhosis of liver with non-cirrhotic controls. J Coll Physicians Surg Pak 2007;17:69-71.  Back to cited text no. 9
Shweta P, Bajrang L, Pandey M, Haldia SS, Rishi JP. A clinical study of cardiovascular dysfunction in patients of cirrhosis of liver. Ann Int Med Dent Res 2016;2:212-5.  Back to cited text no. 10
Ziada D, Gaber R, Kotb N, Ghazy M, Nagy H. Predictive value of N-terminal pro B-type natriuretic peptide in tissue Doppler-diagnosed cirrhotic cardiomyopathy. Heart Mirror J 2011;5:264-70.  Back to cited text no. 11
Henriksen JH, Gøtze JP, Fuglsang S, Christensen E, Bendtsen F, Møller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: Relation to cardiovascular dysfunction and severity of disease. Gut 2003;52:1511-7.  Back to cited text no. 12
Woo JJ, Koh YY, Kim HJ, Chung JW, Chang KS, Hong SP. N-terminal pro B-type natriuretic peptide and the evaluation of cardiac dysfunction and severity of disease in cirrhotic patients. Yonsei Med J 2008;49:625-31.  Back to cited text no. 13
Wong F, Siu S, Liu P, Blendis LM. Brain natriuretic peptide: Is it a predictor of cardiomyopathy in cirrhosis? Clin Sci (Lond) 2001;101:621-8.  Back to cited text no. 14
Tschöpe C, Kasner M, Westermann D, Gaub R, Poller WC, Schultheiss HP. The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: Correlation with echocardiographic and invasive measurements. Eur Heart J 2005;26:2277-84.  Back to cited text no. 15
Dahlström U. Can natriuretic peptides be used for the diagnosis of diastolic heart failure? Eur J Heart Fail 2004;6:281-7.  Back to cited text no. 16
Somani PO, Contractor Q, Chaurasia AS, Rathi PM. Diastolic dysfunction characterizes cirrhotic cardiomyopathy. Indian Heart J 2014;66:649-55.  Back to cited text no. 17
Mihailovici AR, Donoiu I, Gheonea DI, Mirea O, Târtea GC, Buşe M, et al. NT-proBNP and echocardiographic parameters in liver cirrhosis – Correlations with disease severity. Med Princ Pract 2019;28:432-41.  Back to cited text no. 18