Cirrhotic cardiomyopathy

被引:0
作者
Soon Koo Baik
Tamer R Fouad
Samuel S Lee
机构
[1] Yonsei University Wonju College of Medicine,Dept of Medicine
[2] University of Calgary,Liver Unit
来源
Orphanet Journal of Rare Diseases | / 2卷
关键词
Diastolic Dysfunction; Diastolic Function; Cirrhotic Patient; Atrial Natriuretic Peptide; Spontaneous Bacterial Peritonitis;
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摘要
Cirrhotic cardiomyopathy is the term used to describe a constellation of features indicative of abnormal heart structure and function in patients with cirrhosis. These include systolic and diastolic dysfunction, electrophysiological changes, and macroscopic and microscopic structural changes. The prevalence of cirrhotic cardiomyopathy remains unknown at present, mostly because the disease is generally latent and shows itself when the patient is subjected to stress such as exercise, drugs, hemorrhage and surgery. The main clinical features of cirrhotic cardiomyopathy include baseline increased cardiac output, attenuated systolic contraction or diastolic relaxation in response to physiologic, pharmacologic and surgical stress, and electrical conductance abnormalities (prolonged QT interval). In the majority of cases, diastolic dysfunction precedes systolic dysfunction, which tends to manifest only under conditions of stress. Generally, cirrhotic cardiomyopathy with overt severe heart failure is rare. Major stresses on the cardiovascular system such as liver transplantation, infections and insertion of transjugular intrahepatic portosystemic stent-shunts (TIPS) can unmask the presence of cirrhotic cardiomyopathy and thereby convert latent to overt heart failure. Cirrhotic cardiomyopathy may also contribute to the pathogenesis of hepatorenal syndrome. Pathogenic mechanisms of cirrhotic cardiomyopathy are multiple and include abnormal membrane biophysical characteristics, impaired β-adrenergic receptor signal transduction and increased activity of negative-inotropic pathways mediated by cGMP. Diagnosis and differential diagnosis require a careful assessment of patient history probing for excessive alcohol, physical examination for signs of hypertension such as retinal vascular changes, and appropriate diagnostic tests such as exercise stress electrocardiography, nuclear heart scans and coronary angiography. Current management recommendations include empirical, nonspecific and mainly supportive measures. The exact prognosis remains unclear. The extent of cirrhotic cardiomyopathy generally correlates to the degree of liver insufficiency. Reversibility is possible (either pharmacological or after liver transplantation), but further studies are needed.
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[1]  
Kowalski HJ(1953)The cardiac output at rest in Laennec's cirrhosis J Clin Invest 32 1025-1033
[2]  
Abelmann WH(1955)The hemodynamic response to exercise in patients with Laennec's cirrhosis J Clin Invest 34 690-695
[3]  
Abelmann WH(1996)Cirrhotic cardiomyopathy: getting to the heart of the matter Hepatology 24 451-459
[4]  
Kowalski HJ(1999)Cardiopulmonary dysfunction in cirrhosis J Gastroenterol Hepatol 14 600-608
[5]  
McNeely WF(2000)Cirrhotic cardiomyopathy and liver transplantation Liver Transpl 6 S44-S52
[6]  
Ma Z(1989)Cardiac abnormalities in liver cirrhosis West J Med 151 530-535
[7]  
Lee SS(2002)Cirrhotic cardiomyopathy Gastroenterol Clin Biol 26 842-847
[8]  
Liu H(1969)Ventricular function in noncardiacs with alcoholic fatty liver: role of ethanol in the production of cardiomyopathy J Clin Invest 48 397-407
[9]  
Lee SS(1969)Cardiac hemodynamics in alcoholic patients with chronic liver disease and a presystolic gallop J Clin Invest 48 860-868
[10]  
Myers RP(1974)Impaired left ventricular function in alcoholic cirrhosis with ascites. Ineffectiveness of ouabain Circulation 49 754-760