Cirrhotic cardiomyopathy: Implications for liver transplantation

Liu, Hongqun; Jayakumar, Saumya; Traboulsi, Mouhieddin; Lee, Samuel S.

doi:10.1002/lt.24768

Cited by 121 publications

(134 citation statements)

References 81 publications

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“…Although cellular and molecular pathogenic mechanisms underlying CCM have been elucidated in animal models, progress in the diagnosis and management of CCM has been hampered by lack of universally accepted diagnostic criteria . At the Montreal 2005 World Congress of Gastroenterology, an expert consensus panel proposed preliminary criteria for diagnosis of CCM (Table a); but progress in modern concepts of ventricular dysfunction, especially over the past decade, has rendered these criteria obsolete.…”

Section: Redefining Criteria For Ccmmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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Cirrhotic cardiomyopathy (CCM) is cardiac dysfunction in patients with end‐stage liver disease in the absence of prior heart disease. First defined in 2005 during the World Congress of Gastroenterology, CCM criteria consisted of echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Significant advancements in cardiovascular imaging over the past 14 years, including the integration of myocardial deformation imaging into routine clinical practice to identify subclinical cardiovascular dysfunction, have rendered the 2005 CCM criteria obsolete. Therefore, new criteria based on contemporary cardiovascular imaging parameters are needed. In this guidance document, assembled by a group of multidisciplinary experts in the field, new core criteria based on contemporary cardiovascular imaging parameters are proposed for the assessment of CCM. This document provides a critical assessment of the diagnosis of CCM and ongoing assessment aimed at improving clinical outcomes, particularly surrounding liver transplantation. Key points and practice‐based recommendations for the diagnosis of CCM are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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Section: Redefining Criteria For Ccmmentioning

confidence: 99%

Redefining Cirrhotic Cardiomyopathy for the Modern Era

et al. 2019

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“…Although it is often believed that cirrhotic cardiomyopathy resolves post‐LT, the data, albeit limited, do not support this postulation. In fact, the data suggest that diastolic function may not improve post‐transplant and may actually worsen.…”

Section: Discussionmentioning

confidence: 96%

Cirrhotic Cardiomyopathy After Transplantation: Neither the Transient Nor Innocent Bystander

Izzy

Watt

2018

Hepatology

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Cirrhotic cardiomyopathy in end-stage liver disease is currently characterized by blunted contractile systolic response to stress with or without diastolic dysfunction in the absence of known heart disease. Since the establishment of the diagnostic criteria of cirrhotic cardiomyopathy in 2005, there have been multiple studies regarding its pathophysiology and pretransplant clinical course. The data regarding the post-transplant course of this entity are sparse. This review addresses the course and prognosis of the elements of cirrhotic cardiomyopathy after liver transplantation (LT). To this end, there is limited compelling evidence demonstrating the reversibility of this entity post-LT. Cirrhotic cardiomyopathy may, in fact, increase the risk of post-transplant complications. This review reveals a need to refine the diagnostic criteria of cirrhotic cardiomyopathy in view of the remarkable progress in the sphere of echocardiographic evaluation of systolic and diastolic dysfunction. The post-transplant course and outcomes related to cirrhotic cardiomyopathy may be better evaluated in the setting of updated diagnostic criteria.

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“…68 Although strong evidence exists that successful LT reverses the features of cirrhotic cardiomyopathy, 69,70 immediate perioperative stresses may precipitate myocardial dysfunction resulting in clinical heart failure. 71,72 …”

Section: Heart Failure and Cardiomyopathymentioning

confidence: 99%

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

VanWagner

Harinstein

Runo

et al. 2018

American Journal of Transplantation

122

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Liver transplant (LT) candidates today are older, have greater medical severity of illness, and have more cardiovascular comorbidities than ever before. In addition, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Cirrhotic cardiomyopathy, a condition characterized by increased cardiac output and a reduced ventricular response to stress, is present in up to 30% of patients with cirrhosis, thus challenging perioperative management. Current noninvasive tests that assess for subclinical coronary and myocardial disease have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. Therefore, this review, assembled by a group of multidisciplinary experts in the field and endorsed by the American Society of Transplantation Liver and Intestine and Thoracic and Critical Care Communities of Practice, provides a critical assessment of the diagnosis of cardiac and pulmonary vascular disease and interventions aimed at managing these conditions in LT candidates. Key points and practice-based recommendations for the diagnosis and management of cardiac and pulmonary vascular disease in this population are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.

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Cirrhotic cardiomyopathy: Implications for liver transplantation

Cited by 121 publications

References 81 publications

Redefining Cirrhotic Cardiomyopathy for the Modern Era

Redefining Cirrhotic Cardiomyopathy for the Modern Era

Cirrhotic Cardiomyopathy After Transplantation: Neither the Transient Nor Innocent Bystander

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

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