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Year : 2019  |  Volume : 31  |  Issue : 4  |  Page : 508-513

Predictors of myocardial injury in patients with cirrhosis presenting with upper gastrointestinal bleeding

1 Department of Internal Medicine, Critical Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
4 Department of Anaesthesia and ICU, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Hazem Hakim El-Beltagy El-Menshawy
Specialized Medical Hospital, Mansoura University, Mansoura
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejim.ejim_71_18

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Background Myocardial injury in conditions other than coronary artery disease (CAD), known as type 2 myocardial infarction, is mostly related to mismatch between myocardial oxygen supply and demand. Cirrhotic patients with acute upper gastrointestinal bleeding (UGIB) are usually hemodynamically unstable. Hypovolemia, hypotension, and decreased oxygen-carrying capacity as consequences of UGIB may precipitate subclinical heart failure and myocardial injury. Aim of work Assessment of the prevalence and potential risk factors of myocardial injury in patients with liver cirrhosis with acute UGIB. Patients and methods The study was conducted on 132 patients diagnosed with liver cirrhosis presenting by UGIT bleeding at Mansoura University Hospitals during one year. Patients were divided into 2 groups: group 1 (76 patients) with myocardial injury or ischemic heart disease and group 2 (60 patients) without. Results The incidence of myocardial injury in this study (elevated troponin levels above cutoff value and/or ECG changes) was 55% of patients. Troponin I was positive in 25% of patients. ECG ischemic changes were found in 36.3% of patients in the form of ST-segment deviation or T-wave inversion. On univariate analysis, predictors of myocardial injury in patients with UGIB included MELD score and variceal source of GI bleeding. On multivariate analysis variceal source of GI bleeding is an independent predictor of myocardial injury. Variceal bleeding was found in 95 % of the ischemic group versus 63% in the other group. Conclusion More than half of the study patients presented with UGIB have suffered from unnoticed subclinical myocardial injury. Variceal source of GI bleeding was found to be an independent predictor of myocardial injury.

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