Цирротическая кардиомиопатия -синдром, характеризующийся наличием систолической дисфункции, диастолической дисфункции и элек-трофизиологических нарушений у пациентов с циррозом печени в отсутствие других сердеч-но-сосудистых заболеваний. В патогенезе этого состояния играют роль нарушение проведения сигнала β-адренорецепторов, трансмембранных ионных потоков, гиперпродукция вазодилата-торов. Клинические проявления цирротиче-ской кардиомиопатии неспецифичны и скрыты симптомами, характерными для цирроза печени. Несмотря на то что цирротическая кардиомио-патия часто регрессирует после трансплантации печени, дисфункция миокарда может привести к развитию кардиологических осложнений во время трансплантации и в послеоперационном периоде. Тяжелая дисфункция миокарда влияет на исходы трансплантации печени, увеличивая летальность в результате сердечно-сосудистых осложнений, поэтому своевременная диагно-стика цирротической кардиомиопатии важна на этапе обследования кандидата на транспланта-цию печени. Специфического лечения цирроти-ческой кардиомиопатии на данный момент не существует. Рекомендуемое лечение направлено на поддержание функции миокарда и профилак-тику декомпенсации.Ключевые слова: цирроз печени, цирротиче-ская кардиомиопатия, трансплантация печени
Introduction. Liver transplantation restores patients' physical and social life, and its quality. The prevalence of low physical activity in liver recipients is unknown as well as the impact of late liver allograft dysfunction on it. Liver transplantation enhances patient's return to the usual physical and social activity and improves the quality of life. However, the prevalence of low physical activity among liver recipients and the impact of the late allograft dysfunction on it, which is a risk factor for obesity and cardiovascular diseases, require studying.The aim of the study was to identify whether the late liver allograft dysfunction influences the physical activity of recipients.Material and methods. The study included 87 liver recipients. We measured anthropometric parameters, physical performance (SPPB, LFI, 6-min walk test), mean step count per day. Late liver allograft dysfunction was determined if elevated transaminases and/or cholestatic enzymes or hepatic failure have been diagnosed later than 3 months posttransplant. Activity trackers were provided to assess physical activity.Results. Median age was 54 years [45;61], 33% were men. The median follow-up period was 36 months [16;64]. The median of the average steps count was 5.9 [4.1;8.7] thousand per day. 60.5% of recipients were sedentary and low active, 24.4% were somewhat active, 15.1% were active. In cases of liver allograft dysfunction, the mean step count was significantly lower than in patients with normal liver function: 4.1 thousand [2.6;5.3] versus 6.8 thousand [4.2;9.4], p=0.003, despite no differences in the physical activity test results.Conclusion. In case of a late liver allograft dysfunction, the physical activity can decrease; 60.5% of liver recipients, in the absence of pathological restriction of movement, have a sedentary and low active lifestyle. Activity trackers may allow identifying patients who need additional check-up or physical training.
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