ObjectiveTo investigate the potential differences in cardiac lesions between the patients with viral， alcoholic or biliary cirrhosis. MethodsA retrospective analysis was performed for the clinical data of 512 patients who were hospitalized in Hunan Provincial People’s Hospital due to liver cirrhosis from January 2020 to December 2023， and according to the etiology， the patients were divided into viral cirrhosis group with 275 patients， alcoholic cirrhosis group with 70 patients， and biliary cirrhosis group with 167 patients. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test or the Tamhane’s T2 test was used based on homogeneity of variance for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the chi-square test was used for comparison of categorical data between groups. ResultsThere was a significant difference in sex distribution between the three groups， and the male patients accounted for 71.3% in the viral cirrhosis group and 95.7% in the alcoholic cirrhosis group， while the female patients accounted for 64.7% in the biliary cirrhosis group. The biliary cirrhosis group had an age of 61.67±9.59 years， which was significantly higher than that in the other two groups （P<0.05）. Compared with the viral cirrhosis group and the biliary cirrhosis group， the alcoholic cirrhosis group had significantly higher Child-Pugh score （H=30.598， P<0.05）， globulin （H=13.350， P<0.05）， and QTc interval （F=9.956， P<0.05） and significantly lower hemoglobin （F=4.529， P<0.05）， prothrombin activity （F=36.293， P<0.05）， and albumin （F=15.744， P<0.05）. There were no significant differences in each echocardiography parameter between the viral cirrhosis group and the alcoholic cirrhosis group （P>0.05）； compared with the biliary cirrhosis group， the viral cirrhosis group and the alcoholic cirrhosis group had significantly larger left atrial anterior-posterior diameter （H=19.197， P<0.05）， left ventricular end-diastolic diameter （LVEDD） （H=15.660， P<0.05）， right atrial transverse diameter （H=22.854， P<0.05）， mid-right ventricular transverse diameter （H=10.936， P<0.05）， interventricular septal thickness in diastole （IVSd） （H=13.539， P<0.05）， and left ventricular posterior wall thickness in diastole （LVPWd） （H=14.139， P<0.05）； compared with the biliary cirrhosis group， the viral cirrhosis group had a significantly higher mitral ratio of peak early to late diastolic filling velocity （E/A） （P<0.05）. Left ventricular diastolic dysfunction was observed in 170 patients （61.8%） in the viral cirrhosis group， 45 patients （64.3%） in the alcoholic cirrhosis group， and 125 patients （74.9%） in the biliary cirrhosis group， with a significant difference between the three groups （χ²=8.074， P=0.018）. The patients were divided into grade A， B， and C groups based on Child-Pugh score， and comparisons of echocardiography findings between the three groups showed no significant differences in LVEDD， IVSd， LVPWd， E/A， and left ventricular ejection fraction （all P>0.05）. ConclusionThere are differences in cardiac structure and function between patients with different etiologies of liver cirrhosis， and in clinical practice， individualized cardiac assessment and intervention should be performed based on different etiologies.