Cirrhotic cardiomyopathy: Predictors of major adverse cardiac events and assessment of reversibility after liver transplant

Ali, Saad A.; Arman, Huseyin E; Shamsseddin, Hani; Elsner, Nathaniel; Elsemesmani, Hussein; Johnson, Sean; Zenisek, Joseph; Khemka, Abishek; Jarori, Upasana; Patidar, Kavish R.; Orman, Eric S.; Kubal, Chandrashekhar A.; Frick, Kyle

doi:10.1016/j.jjcc.2023.04.007

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…Liver transplantation remains the definitive ‘cure’ for cardiovascular anomalies of cirrhosis. A recent study showed that within one year after liver transplantation, 34% of CCM patients recovered according to the 2005 Montreal criteria and 57% according to the 2019 CCC criteria [ 82 ]. However, the recovery process is challenging, and the overall cardiovascular system experiences both risks and benefits.…”

Section: Managementmentioning

confidence: 99%

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Liu,

Ryu,

Hwang

et al. 2024

IJMS

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Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction associated with cirrhosis in the absence of pre-existing heart disease. CCM manifests as the enlargement of cardiac chambers, attenuated systolic and diastolic contractile responses to stress stimuli, and repolarization changes. CCM significantly contributes to mortality and morbidity in patients who undergo liver transplantation and contributes to the pathogenesis of hepatorenal syndrome/acute kidney injury. There is currently no specific treatment. The traditional management for non-cirrhotic cardiomyopathies, such as vasodilators or diuretics, is not applicable because an important feature of cirrhosis is decreased systemic vascular resistance; therefore, vasodilators further worsen the peripheral vasodilatation and hypotension. Long-term diuretic use may cause electrolyte imbalances and potentially renal injury. The heart of the cirrhotic patient is insensitive to cardiac glycosides. Therefore, these types of medications are not useful in patients with CCM. Exploring the therapeutic strategies of CCM is of the utmost importance. The present review summarizes the possible treatment of CCM. We detail the current status of non-selective beta-blockers (NSBBs) in the management of cirrhotic patients and discuss the controversies surrounding NSBBs in clinical practice. Other possible therapeutic agents include drugs with antioxidant, anti-inflammatory, and anti-apoptotic functions; such effects may have potential clinical application. These drugs currently are mainly based on animal studies and include statins, taurine, spermidine, galectin inhibitors, albumin, and direct antioxidants. We conclude with speculations on the future research directions in CCM treatment.

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Section: Managementmentioning

confidence: 99%

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Liu,

Ryu,

Hwang

et al. 2024

IJMS

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“…Since CCM is clinically silent, and the number of unreported cases is thought to be high, the prevalence and incidence of CCM are rather underdiagnosed. Furthermore, the literature on the prevalence of CCM is conflicting (depending on the diagnostic criteria used) [ 10 , 19 ]. Studies have estimated the prevalence of CCM to be in the range 50-70%, using the 2005 criteria of the Cirrhotic Cardiomyopathy Consortium (CCC), and 29-55.7% using the 2019 criteria [ 19 , 20 ].…”

Section: Epidemiology and Definitionmentioning

confidence: 99%

Update on cirrhotic cardiomyopathy: from etiopathogenesis to treatment

Yumusak

2024

aog

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Cirrhotic cardiomyopathy represents a syndrome of cardiac dysfunction associated with advanced liver disease. It is the result of complex pathophysiological processes that complicate the course of the disease, and is generally associated with a poor prognosis. Pathophysiologically, portal hypertension is the key factor leading to hyperdynamic circulation, via over-activation of the neurohumoral axis. Intestinal obstruction, subclinical inflammation and hepatocellular insufficiency, with defective synthesis or metabolism of several vasoactive mediators, are essential components of this process. Since it is usually unapparent at rest and only unmasked by an inadequate cardiac response to hemodynamic stress, the diagnosis of cirrhotic cardiomyopathy is challenging and demands a multimodal approach. There is currently no specific therapy, but there are prognostically effective drugs available to treat heart failure. Therefore, it is crucial to identify patients with chronic liver disease and heart failure in order to ameliorate their outcome. This article attempts to highlight the most important aspects of cirrhotic cardiomyopathy and draws attention to this condition.

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“…HDI in liver transplantation is multifactorial and can be caused by massive fluid shifts, clamping, and unclamping of the inferior vena cava, surgical bleeding, coagulopathy, myocardial dysfunction, dynamic left ventricular outflow tract obstruction (LVOTO), severe vasodilation, and postreperfusion syndrome (PRS) [1 63,66,67,74]. The prevalence of cirrhotic cardiomyopathy (CCM) ranges from 17.5 to 78.6% according to which diagnostic criteria are used [14]. Blunted chronotropic and inotropic response to stress with sudden circulatory decompensation on exposure to stress are characteristic of CCM and contribute to perioperative morbidity and mortality [14,58,59,74].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of cirrhotic cardiomyopathy (CCM) ranges from 17.5 to 78.6% according to which diagnostic criteria are used [14]. Blunted chronotropic and inotropic response to stress with sudden circulatory decompensation on exposure to stress are characteristic of CCM and contribute to perioperative morbidity and mortality [14,58,59,74]. Intraoperative stresses in the form of sudden hypovolemia, hypervolemia, use of vasopressors and inotropes can trigger decompensation of the cirrhotic heart during liver transplantation [14,58,59,74].…”

Section: Introductionmentioning

confidence: 99%

“…Blunted chronotropic and inotropic response to stress with sudden circulatory decompensation on exposure to stress are characteristic of CCM and contribute to perioperative morbidity and mortality [14,58,59,74]. Intraoperative stresses in the form of sudden hypovolemia, hypervolemia, use of vasopressors and inotropes can trigger decompensation of the cirrhotic heart during liver transplantation [14,58,59,74]. The incidence of intracardiac thrombi (ICT) and pulmonary embolism is 1-6% with an intraoperative mortality of 30-55% [63,74].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

Kandil,

Sedra

2023

Current Opinion in Organ Transplantation

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Purpose of review The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation. Recent findings Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise. Summary The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.

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Cirrhotic cardiomyopathy: Predictors of major adverse cardiac events and assessment of reversibility after liver transplant

Cited by 6 publications

References 26 publications

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Update on cirrhotic cardiomyopathy: from etiopathogenesis to treatment

Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

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