The Prognostic Value of Echocardiography and ECG In Patients with Liver Cirrhosis: A Single-Center Prospective Cohort Study in Myanmar

Abstract

Background Cirrhotic cardiomyopathy remains under-recognized in Southeast Asia, where chronic viral hepatitis and alcohol-related liver disease frequently coexist. The prognostic relevance of the updated 2020 Cirrhotic Cardiomyopathy Consortium (CCC) criteria, particularly the use of global longitudinal strain (GLS), has not been adequately studied in this region. Objectives We aimed to characterize cardiac dysfunction in Myanmar patients with cirrhosis, compare the diagnostic performance of the 2005 and 2020 CCM criteria, and determine cardiac predictors of 1-year mortality. Methods In this prospective cohort study, 200 consecutive cirrhotic patients underwent comprehensive echocardiography with speckle-tracking analysis and standard electrocardiography. The primary endpoint was all-cause mortality at 12 months. Multivariable Cox regression was used to identify independent predictors of death. Results The mean age was 54±11 years. Alcohol-associated liver disease (35%), hepatitis C (30%), and hepatitis B (25%) were the predominant etiologies. Although left ventricular ejection fraction was preserved, GLS was frequently impaired (mean −16.2±3.4%). The 2020 CCC criteria identified cirrhotic cardiomyopathy in 28% of patients compared with 54% by the 2005 criteria. Thirty patients (15%) died during follow-up. GLS <16% (HR 2.10, p<0.001) and QTc prolongation >440 ms (HR 1.75, p=0.018) were independently associated with mortality after adjustment for MELD score. Conclusions Subclinical myocardial dysfunction is common among Myanmar patients with cirrhosis. The 2020 CCC criteria demonstrate improved prognostic discrimination. Both impaired GLS and QTc prolongation independently predict mortality and should be incorporated into routine risk stratification.