Cardiac dysfunction in portal hypertension among patients with cirrhosis and non-cirrhotic portal fibrosis

De, Binay K; Majumdar, Debabrata; Das, Debasish; Biswas, Pranab Kumar; Mandal, S. K.; Ray, Sujay; Bandopadhyay, Kausik; Das, Tapas; Dasgupta, Shyamal; Guru, Supriya

doi:10.1016/s0168-8278(03)00271-x

Cited by 46 publications

(23 citation statements)

References 23 publications

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“…Although no relationship with splanchnic hemodynamics was observed, both parameters indirectly reflect a greater circulatory dysfunction, characteristic of end-stage liver disease. Some studies have suggested that cirrhotic cardiomyopathy may be related to a greater degree of portal hypertension (6,27). In our study, no relationship between the abnormal heart response and the degree of portal hypertension was observed.…”

Section: Discussioncontrasting

confidence: 69%

Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

et al. 2008

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Section: Discussioncontrasting

confidence: 69%

Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

et al. 2008

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“…Nevertheless diastolic dysfunction has been reported even in patients with idiopathic (non cirrhotic) portal hypertension [16], pointing to the role of hemodynamic derangement characterizing advanced cirrhosis [24,29] as the leading factor. Facing these consideration our study was devoted to examine a large series of subjects in whom any factor other than HCV was involved and disease stage was assessed by liver biopsy, excluding patients with far advanced disease.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperdinamic circulation [3], QTc prolongation [4,5], beta-receptors desensitization [6,7], reduced systolic competence under strains [8][9][10][11] and diastolic dysfunction [12][13][14][15][16][17] are the key features of cirrhotic cardiomyopathy. Diastolic dysfunction, characterized by an altered pattern of transmitral flow due to impaired diastolic relaxation of left ventricle, can be easily assessed by echocardiography and accordingly can be considered as a marker of this condition.…”

Section: Introductionmentioning

confidence: 99%

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

Pozzi¹,

Pizzala²,

Ratti³

et al. 2007

TOGASJ

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Evidence of diastolic dysfunction in cirrhosis contributed to the definition of cirrhotic cardiomyopathy. In 109 patients with chronic HCV infection with or without cirrhosis E/A ratio, a Doppler marker of diastolic dysfunction, was decreased in cirrhotics (0.89 ± 0.03 vs controls 1.21 ± 0.07, p < 0.01) and to a lesser extent in patients with advanced liver fibrosis (1.17 ± 0.07, p < 0.01). Left ventricular parietal wall thickness was increased. The nature of this abnormality in human cirrhosis has not been clarified, animal studies reporting cardiac hypertrophy. To this aim we employed the echocardiographic integrated backscatter (IBS) technique to obtain an indirect estimate of tissue density (decreased when a higher percentage of muscle fibres is present and increased when fibrosis prevails) to provide myocardial tissue characterization in a subset of patients with compensated HCV cirrhosis. The average IBS signal was reduced in cirrhotics at the level of the posterior wall (21.72 ± 1.46 dB versus 30.85 ± 1.40 dB in controls, p < 0.01). Our results confirm diastolic dysfunction in postviral cirrhosis pointing to cardiac hypertrophy as the anatomopathological background in the compensated stage of disease.

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“…However, the interpretation of the increased ANP in patients who from a functional point of view suffer from effective hypovolaemia is complex. The RAAS and ANP both contribute to volume regulation and compliance, and seem to be associated with the degree of diastolic dysfunction in cirrhotic, as well as in non-cirrhotic, portal fibrosis [89]. The RAAS and ANP both contribute to volume regulation and compliance, and seem to be associated with the degree of diastolic dysfunction in cirrhotic, as well as in non-cirrhotic, portal fibrosis [89].…”

Section: Diastolic Dysfunctionmentioning

confidence: 98%

Cirrhotic cardiomyopathy

Möller

Henriksen

2010

Journal of Hepatology

282

210

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Increased cardiac output was first described in patients with cirrhosis more than fifty years ago. Later, various observations have indicated the presence of a latent cardiac dysfunction, which includes a combination of reduced cardiac contractility with systolic and diastolic dysfunction and electrophysiological abnormalities. This syndrome is termed cirrhotic cardiomyopathy. Results of experimental studies indicate the involvement of several mechanisms in the pathophysiology, such as reduced beta-adrenergic receptor signal transduction, altered transmembrane currents and electromechanical coupling, nitric oxide overproduction, and cannabinoid receptor activation. Systolic incompetence in patients can be revealed by pharmacological or physical strain and during stressful procedures, such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. Systolic dysfunction has recently been implicated in development of renal failure in advanced disease. Diastolic dysfunction reflects delayed left ventricular filling and is partly attributed to ventricular hypertrophy, subendocardial oedema, and altered collagen structure. The QT interval is prolonged in about half of the cirrhotic patients and it may be normalised by beta-blockers. No specific therapy for cirrhotic cardiomyopathy can be recommended, but treatment should be supportive and directed against the cardiac dysfunction. Future research should better describe the prevalence, impact on morbidity and survival, and look for potential treatments.

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Cardiac dysfunction in portal hypertension among patients with cirrhosis and non-cirrhotic portal fibrosis

Cited by 46 publications

References 23 publications

Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

Cirrhotic cardiomyopathy

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