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Canadian Journal of Gastroenterology
Volume 17, Issue 9, Pages 545-551
Original Article

Cirrhotic Cardiomyopathy: Does it Contribute to Chronic Fatigue and Decreased Health-Related Quality of Life in Cirrhosis?

Nigel Girgrah,1 Graham Reid,2 Shona MacKenzie,1 and Florence Wong1

1Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
2Departments of Psychology and Family Medicine, University of Western Ontario, London, Ontario, Canada

Received 27 January 2003; Revised 10 July 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Diminished health-related quality of life (HRQoL) and fatigue have been reported in patients with cirrhosis. The presence of cirrhotic cardiomyopathy and the attendant poor cardiac response to physical stress may affect HRQoL and contribute to fatigue in these patients.

AIMS: To evaluate the contribution of cirrhotic cardiomyopathy to HRQoL and fatigue in ambulatory cirrhotic patients.

METHODS: Thirty ambulatory cirrhotic patients (14 preascitic, Child-Pugh score 5.6±0.3; 16 ascitic, Child-Pugh score 9.1±0.5) underwent cardiopulmonary exercise testing and assessment of HRQoL, fatigue and depressive symptomatology. HRQoL and fatigue scores were correlated with liver disease severity, depressive symptomatology and parameters of cardiac function and exercise physiology.

RESULTS: Subscales of all HRQoL measuring the effect of disease on the ability to perform physical, social and emotional roles were significantly impaired when compared with controls (P<0.001). The impact of fatigue, as assessed by the Fatigue Assessment Inventory, was greater in cirrhotics (4.46 versus 2.53 in healthy age-matched controls, P<0.01). Diminished HRQoL, impact of fatigue and vitality were related to depressive symptoms rather than to cardiac structural and functional abnormalities, which were present in cirrhotic patients. Poorer physical quality of life scores correlated with diminished mental health.

CONCLUSIONS: Depression, rather than the presence of cirrhotic cardiomyopathy, may have contributed to the diminished HRQoL and vitality in patients with cirrhosis with or without ascites.