To make a comprehensive analysis of liver stiffness and left ventricular functional changes and their correlations in cirrhosis patients with preserved ejection fraction across Child-Pugh classes using two-dimensional shear wave elastography (2D-SWE) and myocardial work (MW).

A total of 110 cirrhosis patients with preserved left ventricular ejection fraction (LVEF) were recruited from Wenjiang District People's Hospital, Chengdu between August 2023 and December 2024. According to Child-Pugh classification, the patients were stratified into Group A (n=34), Group B (n=37), and Group C (n=39). Thirty-six age- and sex-matched healthy volunteers served as controls. Demographics, blood biochemical parameters, liver stiffness measurements (LSM), conventional echocardiographic indices, 2D-SWE, and MW parameters were collected. Intergroup differences were compared and correlations among parameters were analyzed.

LSM was higher in Group A than in controls (P<0.001). Group B showed higher LSM than both controls and Group A (P<0.001). Group C exhibited higher LSM than controls, Group A, and Group B (P<0.05). In terms of LV diastolic function parameters, e' was decreased in Groups A and B compared to the control group (P<0.001), and demonstrated a further reduction in Group C compared to the control group and groups A and B (P<0.001). E/A ratio was lower in Group B than in controls (P<0.001), and was further reduced in Group C compared to the control group and groups A and B (P<0.001). e'/a' ratio was reduced in Group B compared to controls (P<0.001), with Group C showing a more significant decrease compared to the control group and groups A and B (P<0.001). In terms of left ventricular systolic function parameters, LVEF was significantly higher in Groups B and C compared to the control group (P<0.05). The absolute value of global longitudinal strain (GLS) was significantly increased in Group B compared to both the control group and Group A (P<0.001). The absolute GLS value was significantly lower in Group C than in Group B (P<0.001). Peak strain dispersion (PSD) was significantly increased in Group C compared to the control group and Group A (P<0.001). Global constructive work (GCW) was significantly higher in Group B than in controls (P<0.001). GCW was significantly lower in Group C than in Group B (P<0.001). Global work index (GWI) and global work efficiency (GWE) were significantly reduced in Group C compared to the control group, Group A, and Group B (P<0.001). Global wasted work (GWW) was significantly elevated in Group C compared to the control group, Group A, and Group B (P<0.001). Child-Pugh grade correlated positively with LSM, AST, TBA, and GWW (r= 0.872, 0.499, 0.533, and 0.446, respectively; P<0.001), and negatively with DBP, E/A, e', e'/a', and GWE (r=−0.483, −0.562, −0.669, −0.659, and −0.479, respectively; P<0.001). LSM showed positive correlations with CO, AST, and TBA (r=0.467, 0.584, and 0.585, respectively; P<0.001), and negative correlations with DBP, E/A, e', and e'/a' (r=−0.513, −0.491, −0.542, and −0.571, respectively; P<0.001).

With the worsening of Child-Pugh classification in liver cirrhosis, liver dysfunction deteriorates, accompanied by increased LSM values and heightened measurement dispersion, left ventricular diastolic function declines, and systolic function initially exhibits compensatory enhancement but subsequently undergoes decompensatory reduction. Liver-heart functional impairment demonstrates synergistic effects. The combined use of 2D-SWE and MW techniques provided a more comprehensive and effective assessment of liver disease severity and left ventricular functional changes in cirrhotic patients, which offered crucial imaging evidence for targeted clinical interventions and improving patient prognosis.