Advances in cirrhotic cardiomyopathy

Abstract

Purpose of review Cirrhotic cardiomyopathy (CCM) is a well-recognized entity. When patients with CCM encounter challenges such as liver transplantation, overt cardiac dysfunction manifests, leading to morbidity and mortality. Although revised diagnostic criteria for CCM have recently been proposed, these still need to be validated. Recent findings Previous reviews have summarized the mechanisms of CCM, such as abnormalities of the β-adrenergic pathway, cardiac plasma membrane biophysical and biochemical properties, and electrophysiological changes. Cardiomyocyte apoptosis, inflammation, and oxidative stress also play important roles. The present review details further mechanisms of CCM, which include myosin heavy chain isoform shifts and abnormalities in cellular calcium transients. Additionally, we review recent studies on therapeutic strategies. Recent work underscores the importance of CCM in the natural history of the immediate and medium-term postoperative period after liver transplantation. Appropriate management strategies for CCM remain the area of greatest unmet need, requiring much further research. Summary CCM is a clinically relevant syndrome affecting patients with cirrhosis, leading to increased morbidity and mortality. New diagnostic criteria have been recently proposed by an expert working group. The pathogenic mechanisms remain incompletely clarified and optimal management strategies need much further study.

The predictive value of revised diastolic dysfunction in outcomes of liver transplantation: A propensity score matching analysis

“…This retrospective study enrolled patients aged 18-70 years, diagnosed with decompensated cirrhosis (8) at the Affiliated Hospital of Qingdao University, Qingdao, China, between January 2018 and March 2021. Patients were divided into two groups (DD or non-DD group), according to echocardiographic examinations of cardiac diastolic function a week before operation, based on the revised 2019 CCC criteria (9)(10)(11). DD was determined if three of the following criteria were met: E/e' > 15, LAVI > 34 ml/m 2 , e' < 7 cm/s or TRV > 2.8 m/s.…”

Altered serum bile acid composition is associated with cardiac dysfunction in cirrhosis

“…Cardiac dysfunction in patients with cirrhosis includes both structural and functional cardiac abnormalities and these changes have been gathered as the entity: Cirrhotic cardiomyopathy (CCM). 1 Numerous studies have demonstrated the clinical importance of CCM as a contributing factor in the development of complications and risk of death in patients with cirrhosis. [2][3][4] Nevertheless, the underlying pathogenesis of these cardiac abnormalities is not yet fully understood.…”

Correlation analysis between myocardial work indices and liver function classification in patients with hepatitis B cirrhosis: A study with non-invasive left ventricular pressure-strain loop

“…It comprises a triad of impaired myocardial contractile responses to stress (systolic dysfunction), inadequate ventricular relaxation (diastolic dysfunction), and electrophysiological abnormalities in the absence of any known cardiac disease ( 3 ). Patients with cirrhosis may have various cardiovascular complications and even induce heart failure under stress conditions such as load or clinical invasive operation ( 4 , 5 ). Heart failure due to CCM is claimed to the third cause of mortality in liver transplant patients following infection and rejection ( 6 ).…”