Cirrhotic Cardiomyopathy

Yoon, Ki Tae; Liu, Hongqun; Lee, Samuel S.

doi:10.1007/s11894-020-00783-1

Cited by 51 publications

(67 citation statements)

References 66 publications

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“…Nam and colleagues have demonstrated a pathogenic role of increased cardiomyocyte apoptosis in rat CCM 134 . More detailed discussion of these mechanisms can be found in a recent review 44 …”

Section: Pathogenic Mechanismsmentioning

confidence: 99%

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Review article: comprehensive analysis of cirrhotic cardiomyopathy

Chahal

Liu

Shamatutu

et al. 2021

Aliment Pharmacol Ther

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SummaryBackgroundPatients with cirrhosis are at risk of developing cirrhotic cardiomyopathy. This syndrome is unique to cirrhosis and is generally defined as subnormal cardiac function in the absence of prior heart disease. There is no systematic or comprehensive review of cirrhotic cardiomyopathy to date.AimsTo comprehensively review the literature on the definition, pathogenic mechanisms, diagnostic criteria, prevalence, management and influence on liver transplantation including reversibility of cirrhotic cardiomyopathy.MethodsElectronic searches of the EMBASE, MEDLINE, EBM Reviews—Cochrane Central Register of Controlled Trials, EBM Reviews—Cochrane Database of Systematic Reviews and Google Scholar databases were conducted. MeSH terms focused on cirrhosis, cardiomyopathy, medication classes and epidemiology. Literature up to August 2020 was reviewed.ResultsNew diagnostic criteria for the definition of cirrhotic cardiomyopathy have recently been published, consisting of systolic and diastolic dysfunction parameters as assessed by echocardiographic methods. The roles of electrocardiographic disturbances and biomarkers in the definition criteria remain unclear. Pathogenic mechanisms underlying cirrhotic cardiomyopathy are likely related to the inflammatory phenotype of cirrhosis. Prevalence rates of 26%‐81% in cirrhotic patients are reported. Several medical therapies have been proposed, but none with clear evidence of efficacy. The presence of cirrhotic cardiomyopathy complicates the liver transplantation process with a higher risk of adverse cardiovascular events post‐transplant. Complete reversibility of the syndrome after transplantation remains controversial but most studies suggest that it does not occur at least within the first post‐operative year.ConclusionsCirrhotic cardiomyopathy is a clinically relevant syndrome that affects morbidity and mortality in patients with cirrhosis.

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Section: Pathogenic Mechanismsmentioning

confidence: 99%

“…Development of CCM is thought to be independent of the underlying aetiology of cirrhosis 42‐44 . As such, prevalence of CCM should be equal across groups of patients with differing aetiologies of cirrhosis.…”

Section: Prevalence Of Cirrhotic Cardiomyopathymentioning

confidence: 99%

Review article: comprehensive analysis of cirrhotic cardiomyopathy

Chahal

Liu

Shamatutu

et al. 2021

Aliment Pharmacol Ther

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“…As a result, these factors induce gut translocation of bacteria and endotoxin, and unleash a humoral and cell-mediated inflammatory response, known as the “inflammatory phenotype” [ 21 , 23 ]. In cirrhosis, the inflammatory phenotype may be involved in the pathogenesis of several cardiovascular complications, including cirrhotic cardiomyopathy [ 24 ].…”

Section: Nsbbs Alleviate Systemic Inflammationmentioning

confidence: 99%

β-blockers in advanced cirrhosis: More friend than enemy

2021

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Nonselective beta-adrenergic blocker (NSBB) therapy for the prevention of initial and recurrent gastrointestinal bleeding in cirrhotic patients with gastroesophageal varices has been used for the past four decades. NSBB therapy is considered the cornerstone of treatment for varices, and has become the standard of care. However, a 2010 study from the group that pioneered β-blocker therapy suggested a detrimental effect of NSBBs in decompensated cirrhosis, especially in patients with refractory ascites. Since then, numerous additional studies have incompletely resolved whether NSBBs are deleterious, although more recent evidence weighs against a harmful effect. The possibility of a “therapeutic window” has also been raised. We aimed to review the literature to analyze the pros and cons of using NSBBs in patients with cirrhosis, not only with respect to bleeding or mortality but also to other potential benefits and risks. β-blockers are highly effective in preventing first bleeding and recurrent bleeding. Furthermore, NSBBs improve congestion/ischemia of the gut mucosa, decrease intestinal permeability, and therefore indirectly alleviate systemic inflammation. β-blockers shorten the electrocardiographic prolonged QTc interval and may also decrease the incidence of hepatocellular carcinoma. On the other hand, the possibility of deleterious effects in cirrhosis has not been completely eliminated. NSBBs may be associated with an increased risk of portal vein thrombosis, although this could be correlational artifact. Overall, we conclude that β-blockers in cirrhosis are much more of a friend than enemy.

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“…RAAS inhibition with angiotensin converting enzyme inhibitors (ACEi) or angiotensin II type 1 receptor blockers (ARBs) has been shown to be effective in the attenuation of liver fibrosis in an experimental model and in clinical trials [ 16 , 17 ]. However, RAAS inhibitors are contraindicated in decompensated cirrhosis because of the risk of hypotension and hepatorenal syndrome [ 18 ]. They would be an important treatment option to attenuate the progression of early-stage cirrhosis.…”

Section: The Mechanisms Of Ascites In Cirrhosismentioning

confidence: 99%

Management of Cirrhotic Ascites under the Add-on Administration of Tolvaptan

Adachi¹,

Takeuchi²,

Takaki³

et al. 2021

IJMS

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Tolvaptan is a recently available diuretic that blocks arginine vasopressin receptor 2 in the renal collecting duct. Its diuretic mechanism involves selective water reabsorption by affecting the water reabsorption receptor aquaporin 2. Given that liver cirrhosis patients exhibit hyponatremia due to their pseudo-aldosteronism and usage of natriuretic agents, a sodium maintaining agent, such as tolvaptan, is physiologically preferable. However, large scale studies indicating the patients for whom this would be effective and describing management under its use have been insufficient. The appropriate management of cirrhosis patients treated with tolvaptan should be investigated. In the present review, we collected articles investigating the effectiveness of tolvaptan and factors associated with survival and summarized their management reports. Earlier administration of tolvaptan before increasing the doses of natriuretic agents is recommended because this may preserve effective arterial blood volume.

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Cirrhotic Cardiomyopathy

Cited by 51 publications

References 66 publications

Review article: comprehensive analysis of cirrhotic cardiomyopathy

Review article: comprehensive analysis of cirrhotic cardiomyopathy

β-blockers in advanced cirrhosis: More friend than enemy

Management of Cirrhotic Ascites under the Add-on Administration of Tolvaptan

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