Cirrhotic cardiomyopathy: comprehensive insights into pathophysiology, diagnosis, and management

Cirrhotic cardiomyopathy (CCM) is a cardiac dysfunction linked to chronic liver disease, primarily characterized by impaired cardiac response to stress, despite normal baseline function. It presents with both systolic and diastolic dysfunction, along with electrophysiological changes such as QT interval prolongation. CCM is driven by a combination of systemic inflammation, nitric oxide-induced vasodilation, and neurohormonal dysregulation, leading to myocardial impairment and abnormal vascular responses. Clinically, CCM often remains asymptomatic at rest, but patients may experience exercise intolerance or heart failure during stress. Diagnosis includes echocardiographic evaluation, biomarker analysis (NT-proBNP, troponins), and electrocardiography for detecting electrophysiologic abnormalities. Management is complicated by cirrhosis, limiting the use of conventional heart failure treatments, with liver transplantation being the most definitive intervention in severe cases. Early detection of CCM is vital, particularly for patients undergoing liver transplantation or major surgery, where cardiac complications can increase mortality. Further research is necessary to refine diagnostic criteria and treatment strategies.