New insights into cirrhotic cardiomyopathy

Möller, Sören; Hove, Jens D.; Dixen, Ulrik; Bendtsen, Flemming

doi:10.1016/j.ijcard.2012.09.089

Cited by 94 publications

(115 citation statements)

References 80 publications

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“…Portal hypertension and altered liver function may play an important role in the change of intracardiac volume and pressure conditions in cirrhosis [8,9]. Variceal bleeding, concomitant anemia and the appearance of ascites are among the most important factors that contribute to the decreased right and left ventricular preload and afterload [10].…”

Section: Role Of the Vascular Tone In The Genesis Of Cirrhotic Cardiomentioning

confidence: 99%

“…The pathophysiological background of the diastolic dysfunction in cirrhosis is the increased stiffness of the myocardial wall, which is often caused by myocardial hypertrophy and fibrosis due to activation of the RAAS [29]. Subendothelial edema and increased interstitial collagen deposition play a further role in the decreased ability for relaxation [2,8]. Based on the severity of diastolic heart function, patients may be relatively asymptomatic.…”

Section: Diastolic Functionmentioning

confidence: 99%

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Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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Hyperdynamic circulation, systolic and diastolic left ventricular dysfunction and certain electrophysiological abnormalities have been associated with cirrhosis and known for a long time. These clinical features have been introduced as cirrhotic cardiomyopathy (CCM), which is characterized by blunted myocardial contractile responsiveness to physical, physiological and pharmacological stress. Importantly, cardiac dysfunction can be reversible and can improve due to effective medical treatment and also after liver transplantation. Echocardiography and electrocardiography are essential tools for recognizing the characteristic changes in the myocardial function and also the alterations in the electrophysiological properties of the heart. Laboratory markers are auxiliary modalities further aiding the establishment of the correct diagnosis. In this review, we aimed to collect the pathophysiological background and clinical characteristics of CCM with the intention of summarizing the current possibilities for the diagnosis establishment and treatment of this cardio-hepatic disorder.Abbreviations: A: late diastolic transmitral peak flow velocity; ACE: angiotensin converting enzyme; ANP: atrial natriuretic peptide; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; cAMP: cyclic adenosine monophosphate; CCM: cirrhotic cardiomyopathy; CGRP: calcitonin gene-related peptide; CO: carbon monoxide; DD: diastolic dysfunction; DT: deceleration time; E: early diastolic transmitral peak flow velocity; Ea: early diastolic velocity of the septal mitral annulus; EF: ejection fraction; MUGA: Multi Gated Acquisition Scan; NO: nitric oxide; NSBB: non-selective beta-blocker; pro-BNP: pro-brain natriuretic peptide; QTc: corrected QT interval; RAAS: renin-angiotensin aldosterone system; RALES: Randomized Aldactone Evaluation Study; suPAR: urokinase-type plasminogen activator receptor; TDI: Tissue Doppler Imaging; TIPS: transjugular intrahepatic portosystemic shunt; TNF-alpha: tumor necrosis factor-alpha.

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Section: Role Of the Vascular Tone In The Genesis Of Cirrhotic Cardiomentioning

confidence: 99%

Section: Diastolic Functionmentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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“…Subsequent studies revealed that cirrhosis is associated with a hyperdynamic circulation (increased cardiac output and diminished systemic vascular resistance) [2][3][4][5][6] , which corresponds to a high-output heart failure under resting conditions [7,8] . This clinical entity, formally named cirrhotic cardiomyopathy (CCM), is unrelated to the etiology of cirrhosis [3][4][5][8][9][10] and is different from alcoholic disease [9] .…”

Section: Introductionmentioning

confidence: 99%

“…Systolic dysfunction relates to the inability of the heart to maintain an adequate arterial blood pressure and output [5][6][7] . QT interval prolongation is the main electrophysiological abnormality in cirrhosis [2][3][4][5][6][7][8]13,14] .…”

Section: Introductionmentioning

confidence: 99%

“…QT interval prolongation is the main electrophysiological abnormality in cirrhosis [2][3][4][5][6][7][8]13,14] . Several mechanisms have been implicated in the impaired contractile function of the cardiomyocyte: Down-regulation of β-adrenergic receptors and impaired β-adrenergic signalling, altered cardiomyocyte plasma membrane biophysical characteristics, increased activity of the endocannabinoids, nitric oxide and cytokines systems, as well as abnormal myofilaments [3][4][5][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

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Cirrhotic cardiomyopathy: Isn’t stress evaluation always required for the diagnosis?

Barbosa

Guardado

Marinho

et al. 2016

WJH

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Author contributions: All authors had made substantial con tributions to the study; Barbosa M, Guardado J, Marinho C, Quelhas I and Cotter J participated in the study concept and design; Barbosa M, Guardado J, Rosa B and Quelhas I were involved in acquisition, analysis and interpretation of the data; Barbosa M, Guardado J and Rosa B performed statistical analysis; Barbosa M and Guardado J drafted the manuscript; Marinho C, Quelhas I, Lourenço A and Cotter J reviewed the manuscript; all authors read and approved the final manuscript.Institutional review board statement: This study was approved by the Institutional Review Board of Centro Hospitalar do Alto Ave, Guimarães, Portugal.Informed consent statement: Written informed consent was obtained from every patient included in the study. Abstract AIM: To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease. METHODS:A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected. Dobutamine stress echocardiography (conventional and tissue Doppler imaging) was performed. CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress. Therapy interfering with cardiovascular system was suspended 24 h before the examination. RESULTS:Twenty-six patients were analyzed, 17 (65.4%) Child-Pugh A, mean model for end-stage liver disease (MELD) score of 8.7. The global proportion of patients with CCM was 61.5%. At rest, only 2 (7.7%) patients had diastolic dysfunction and none of the patients had systolic dysfunction. Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6 (23.1%) patients and of systolic Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis? Observational StudyORIGINAL ARTICLE dysfunction in 10 (38.5%) patients. QTc interval prolongation was observed in 68.8% of the patients and increased pro-BNP levels in 31.2% of them. There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD (P = 0.775, P = 0.532, respectively). Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation (95.0% vs 50.0%, P = 0.028). CONCLUSION:CCM is a frequent complication of cirrhosis that is independent of liver impairment. Stress evaluation should always be performed, otherwise it will remain an underdiagnosed condition. Core tip: Our study demonstrates that cirrhotic cardiomyopathy (CCM) is a frequent condition that is independent of the severity of liver disease. Furthermore, it shows that CCM ...

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