Journal Article

Recent Advances in Cirrhotic Cardiomyopathy

Vlachogiannakos, Jiannis, Papatheodoridis, George, Karagiannakis, Dimitrios S.

2015

Overview

Cirrhotic cardiomyopathy, a cardiac dysfunction presented in patients with cirrhosis, represents a recently recognized clinical entity. It is characterized by altered diastolic relaxation, impaired contractility, and electrophysiological abnormalities, in particular prolongation of the QT interval. Several mechanisms seem to be involved in the pathogenesis of cirrhotic cardiomyopathy, including impaired function of beta-receptors, altered transmembrane currents, and overproduction of cardiodepressant factors, like nitric oxide, tumor necrosis factor α, and endogenous cannabinoids. Diastolic dysfunction is the first manifestation of cirrhotic cardiomyopathy and reflects the increased stiffness of the cardiac mass, which leads to delayed left ventricular filling. On the other hand, systolic incompetence is presented later, is usually unmasked during pharmacological or physical stress, and predisposes to the development of hepatorenal syndrome. The prolongation of QT is found in about 50 % of cirrhotic patients, but rarely leads to fatal arrhythmias. Cirrhotics with blunted cardiac function seem to have poorer survival rates compared to those without, and the risk is particularly increased during the insertion of transjugular intrahepatic portosystemic shunt or liver transplantation. Till now, there is no specific treatment for the management of cirrhotic cardiomyopathy. New agents, targeting to its pathogenetical mechanisms, may play some role as future therapeutic options.

• Publisher: Springer US,Springer,Springer Nature B.V
• Subject: Action Potentials / Animals / Arrhythmia / Biochemistry / Cardiac patients / Cardiomyopathies - diagnosis / Cardiomyopathies - etiology / Cardiomyopathies - metabolism / Cardiomyopathies - mortality / Cardiomyopathies - physiopathology / Cardiomyopathies - therapy / Cardiomyopathy / Cardiovascular Agents - therapeutic use / Gastroenterology / Heart / Heart Conduction System - metabolism / Heart Conduction System - pathology / Heart Conduction System - physiopathology / Heart diseases / Heart Ventricles - metabolism / Heart Ventricles - pathology / Heart Ventricles - physiopathology / Hemodynamics / Hepatology / Humans / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - mortality / Liver Cirrhosis - surgery / Liver Transplantation / Medicine / Medicine & Public Health / Myocardium - metabolism / Myocardium - pathology / Nitric oxide / Oncology / Prognosis / Review / Risk Assessment / Risk Factors / Transplant Surgery / Transplantation of organs, tissues, etc / Tumor necrosis factor / Ventricular Function