Cirrhotic cardiomyopathy

Milani, Alessandro; Zaccaria, Renata; Bombardieri, G.; Gasbarrini, Antonio; Pola, Paolo

doi:10.1016/j.dld.2006.12.014

Cited by 62 publications

(74 citation statements)

References 132 publications

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“…Worsening of cardiac function after OLT, however, is brief and resolves within about 6 months, when the hyperdynamic circulation disappears. A normalization of cardiac function and amelioration of electrophysiological abnormalities are usually observed in these patients [78,85,86]. In conclusion, clinical understanding of CC in endstage liver disease is the best way to avoid life-threatening consequences in patients undergoing special procedures (TIPS or OLT).…”

Section: Cirrhotic Cardiomyopathymentioning

confidence: 91%

Clinical implications of the hyperdynamic syndrome in cirrhosis

Licata

Mazzola

Ingrassia

et al. 2014

European Journal of Internal Medicine

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The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome. Some of these are well described and directly related to portal hypertension (varices, ascites, hepatic encephalopathy, and hepatorenal syndrome), while others, such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, are less known as clinical manifestations related to cirrhosis and, therefore, merit further investigation.

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Section: Cirrhotic Cardiomyopathymentioning

confidence: 91%

Clinical implications of the hyperdynamic syndrome in cirrhosis

Licata

Mazzola

Ingrassia

et al. 2014

European Journal of Internal Medicine

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“…Multiple pathogenic mechanisms have been implicated in the development of cirrhotic cardiomyopathy [33,34] . The diminished inotropic and chronotropic responses to sympathetic stimulation are mainly secondary to a significant down-regulation (reduced density and function) of the β-adrenergic receptors [35] following long-term exposure to persistently high levels of catecholamines [36] .…”

Section: Pathophysiologymentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

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Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

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“…In 1953, Kowalski and Abelmann described the possibility of cardiac dysfunction in patients with liver cirrhosis and attributed its occurrence to the eventual metabolic complications of alcohol intake or hemochromatosis (1). Since then, collective evidence has led to the development of the term "cirrhotic cardiomyopathy" which refers to a state of hyperdynamic circulation with a baseline increase in cardiac output, decrease in peripheral vascular resistance, blunted systo-diastolic response to physical and pharmacological stress, electrophysiological abnormalities, and slight histo-morphological changes in the context of liver cirrhosis (2). The pathophysiology of cirrhotic cardiomyopathy is not yet fully understood, but abnormal membrane biophysical characteristics, impaired β-adrenergic receptor signal transduction and increased activity of negative inotropic pathways mediated by cGMP may be implicated (3).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Cardiac Function in Patients with Liver Cirrhosis

Abdelaziz

Abdou

Fathy³

et al. 2010

Intern. Med.

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Aim of the study To study the cardiac function in patients with liver cirrhosis. Methods Thirty patients with liver cirrhosis, referred to as group I (G 1), were selected. They were subdivided according to Child-Pugh classification into 3 groups: A, B, and C. Thirty healthy subjects, referred to as group II (G II), were selected as a control group. All persons were examined by resting ECG, abdominal ultrasound, laboratory tests, and echo-Doppler evaluation of systolic and diastolic functions of both ventricles using 2-D, M-mode, conventional Doppler, and tissue Doppler parameters. Results Systolic and diastolic blood pressures were significantly reduced with increased resting HR and CO in G I (p<0.05). The QTc interval was prolonged in G I (0.45±0.03 ms; p<0.001) but EDV, ESV, EF%, and S´velocity were not significantly different in both study groups for both ventricles. LAD, MPI, LVPWT, and, IVST were significantly increased in G I (p<0.05). E/A and E´/A´ratios were reversed in G I with increased DT/E for both ventricles (p<0.001). No significant difference was found among Child A, B, C subgroups except for the LAD which was significantly increased in Child C (p<0.05). There was a significant inverse correlation between serum albumin and left ventricular MPI (r 0.4, p<0.05). Conclusion Many cardiovascular abnormalities occur in patients with liver cirrhosis that mandate echocardiographic evaluation especially in cases who undergo any procedure which may affect the hemodynamics.

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Cirrhotic cardiomyopathy

Cited by 62 publications

References 132 publications

Clinical implications of the hyperdynamic syndrome in cirrhosis

Clinical implications of the hyperdynamic syndrome in cirrhosis

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Evaluation of Cardiac Function in Patients with Liver Cirrhosis

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