An update on cirrhotic cardiomyopathy

Expert Rev Gastroenterol Hepatol. 2019 May;13(5):497-505. doi: 10.1080/17474124.2019.1587293. Epub 2019 Mar 8.

Abstract

Cirrhosis with portal hypertension and related complications are associated with a high mortality. Excess of circulating vasodilators and cardiodepressive substances lead to a hyperdynamic circulation with changed myocardial structure and function. The entity cirrhotic cardiomyopathy seems to be involved in different aspects of hepatic decompensation, which focuses on new targets of treatment. Areas covered: This review deals with contemporary aspects of cirrhotic cardiomyopathy, and the literature search was undertaken by PubMed with 'cirrhotic' and 'cardiomyopathies' as MeSH Terms. Cirrhotic cardiomyopathy is defined as the presence of systolic and diastolic dysfunction and electrophysiological abnormalities. The diagnosis is based on contemporary Doppler/Echocardiography measurements or quantitative magnetic resonance imaging. Cirrhotic cardiomyopathy is independent of the etiology of the liver disease but related to severity and survival. Expert commentary: The outcome of invasive procedures and liver transplantation is influenced by the presence of cardiac dysfunction. Therefore, a cautious cardiac evaluation should be included in the patient evaluation prior to liver transplantation. Liver transplantation ameliorates most of the abnormalities seen in cirrhotic cardiomyopathy, but no specific treatment can yet be recommended.

Keywords: Cirrhotic cardiomyopathy; QT-interval; arterial vasodilatation; cardiovascular dysfunction; cirrhosis; diastolic dysfunction; heart failure; hyperdynamic circulation; liver transplantation; portal hypertension; systolic dysfunction.

Publication types

  • Review

MeSH terms

  • Animals
  • Cardiomyopathies / diagnostic imaging
  • Cardiomyopathies / etiology*
  • Cardiomyopathies / physiopathology
  • Hemodynamics*
  • Humans
  • Liver Circulation
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / surgery
  • Liver Transplantation
  • Risk Factors
  • Treatment Outcome