Left ventricular diastolic dysfunction (LVDD) is the predominant cardiac abnormality in cirrhosis. We investigated the association of LVDD with systemic inflammation and its impact on renal function, occurrence of hepatorenal syndrome (HRS) and survival in patients with cirrhosis and ascites. We prospectively enrolled 215 patients with cirrhosis and ascites. We evaluated the diagnosis and grading of LVDD by Doppler echocardiography, inflammatory markers, systemic hemodynamics, vasoactive factors, radioisotope-assessed renal function and blood flow, HRS development and liver-related mortality. LVDD was diagnosed in 142 (66%) patients [grade 2/3: n = 61 (43%)]. Serum lipopolysaccharide-binding protein (LBP), plasma renin activity (PRA) and glomerular filtration rate (GFR) were independently associated with the presence of grade 2/3 LVDD and the severity of diastolic dysfunction. Serum tumor necrosis factor-α, cardiac output and plasma noradrenaline were also independently associated with the presence of grade 2/3 LVDD. The diastolic function marker E/e' was strongly correlated with serum LBP (r = 0.731; P < 0.001), PRA (r = 0.714; P < 0.001) and GFR (r = -0.609; P < 0.001) among patients with LVDD. The 5-year risk of HRS development and death was significantly higher in patients with grade 2/3 LVDD compared to those with grade 1 (35.5 vs. 14.4%; P = 0.01 and 53.3 vs. 28.2%; P = 0.03, respectively). The occurrence and severity of LVDD in patients with cirrhosis and ascites is closely related to inflammatory activity. Advanced LVDD is associated with baseline circulatory and renal dysfunction, favoring HRS development, and increased mortality.

中文翻译：

---

肝硬化腹水患者左心室舒张功能障碍与炎症活动、肾功能障碍和肝脏相关死亡率的关系。

左心室舒张功能障碍（LVDD）是肝硬化中主要的心脏异常。我们研究了 LVDD 与全身炎症的关系及其对肝硬化腹水患者肾功能、肝肾综合征 (HRS) 发生和生存的影响。我们前瞻性招募了 215 名肝硬化腹水患者。我们通过多普勒超声心动图、炎症标志物、全身血流动力学、血管活性因子、放射性同位素评估的肾功能和血流量、HRS 发展和肝脏相关死亡率来评估 LVDD 的诊断和分级。 142 名 (66%) 患者被诊断为 LVDD [2/3 级：n = 61 (43%)]。血清脂多糖结合蛋白（LBP）、血浆肾素活性（PRA）和肾小球滤过率（GFR）与2/3级LVDD的存在和舒张功能障碍的严重程度独立相关。血清肿瘤坏死因子-α、心输出量和血浆去甲肾上腺素也与 2/3 级 LVDD 的存在独立相关。 LVDD 患者的舒张功能标志物 E/e' 与血清 LBP（r = 0.731；P < 0.001）、PRA（r = 0.714；P < 0.001）和 GFR（r = -0.609；P < 0.001）强相关。 。与 1 级患者相比，2/3 级 LVDD 患者发生 HRS 和死亡的 5 年风险显着更高（分别为 35.5 vs. 14.4%；P = 0.01 和 53.3 vs. 28.2%；P = 0.03） 。肝硬化腹水患者LVDD的发生及严重程度与炎症活动密切相关。晚期 LVDD 与基线循环和肾功能障碍相关，有利于 HRS 的发展并增加死亡率。