Abstract
Liver cirrhosis is associated with several cardiovascular disturbances. These disturbances include hyperdynamic systemic circulation, manifested by an increased cardiac output and decreased peripheral vascular resistance and arterial pressure. Despite the baseline increase in cardiac output, cardiac function in patients with cirrhosis is abnormal in several respects. Patients show attenuated systolic and diastolic contractile responses to stress stimuli, electrophysiological repolarization changes, including prolonged QT interval, and enlargement or hypertrophy of cardiac chambers. This constellation of cardiac abnormalities is termed cirrhotic cardiomyopathy. It has been suggested that cirrhotic cardiomyopathy has a role in the pathogenesis of cardiac dysfunction and even overt heart failure after transjugular intrahepatic portosystemic shunt placement, major surgery and liver transplantation. Cardiac dysfunction contributes to morbidity and mortality after liver transplantation, even in many patients who have no prior history of cardiac disease. Depressed cardiac contractility contributes to the pathogenesis of hepatorenal syndrome, especially in patients with spontaneous bacterial peritonitis. Pathogenic mechanisms underlying cirrhotic cardiomyopathy include cardiomyocyte-membrane biophysical changes, attenuation of the stimulatory β-adrenergic system and overactivity of negative inotropic systems mediated via cyclic GMP. The clinical features, general diagnostic criteria, pathogenesis and treatment of cirrhotic cardiomyopathy are discussed in this review.
Key Points
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Cirrhotic cardiomyopathy can be found in patients with any form of cirrhosis
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Cardinal features of cirrhotic cardiomyopathy include blunted contractile responses to stress and repolarization abnormalities
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Multiple pathogenic mechanisms in the cardiomyocyte plasma membrane are responsible for cirrhotic cardiomyopathy
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Treatment measures for cirrhotic cardiomyopathy are mainly supportive and empirical
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Cardiac function generally normalizes after liver transplantation
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Acknowledgements
SA Gaskari and H Honar contributed equally to this article. SA Gaskari is supported by a Heart and Stroke Foundation of Canada Doctoral Research award, and SS Lee, by an Alberta Heritage Foundation for Medical Research Senior Scholarship award.
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Gaskari, S., Honar, H. & Lee, S. Therapy Insight: cirrhotic cardiomyopathy. Nat Rev Gastroenterol Hepatol 3, 329–337 (2006). https://doi.org/10.1038/ncpgasthep0498
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DOI: https://doi.org/10.1038/ncpgasthep0498
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