Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis

Abstract

Cirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with advanced disease. Down-regulation and decreased number of beta-adrenergic receptors, and high catecholamine levels are common to both cardiac conditions. Thus, AI may play a role in CCM. Steroid replacement therapy reverses cardiac changes in AI, and may do so for CCM, with important therapeutic implications; this needs formal evaluation.

Herbal Supplement Ameliorates Cardiac Hypertrophy in Rats with CCl4-Induced Liver Cirrhosis

“…Patients with advanced cirrhosis have consistently been diagnosed with cardiac dysfunction under the condition of hyperdynamic circulation [1]. Increased cardiac output and reduced systemic vascular resistance are both signs of this condition [2–4].…”

Cardiovascular predictors of death in patients with cirrhosis

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Current Issues in Pediatric Liver Transplantation

“…9 CC may present within months of the onset of liver failure. It is usually clinically latent or mild, likely because the peripheral vasodilatation significantly reduces the left ventricle afterload.…”