Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Liu, Hongqun; Naser, Jwan A.; Lin, Grace; Lee, Samuel S.

doi:10.1016/j.jhepr.2023.100911

Cited by 7 publications

(7 citation statements)

References 128 publications

(181 reference statements)

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“…In this regard, previous studies identified the presence of LVDD [36,37] and E/eʹ [10][11][12]39] as independent predictors of death in patients with cirrhosis. We are aware that the main limitation of our study is that LVDD was defined by the 2009 and not newer ASE criteria [4] taking into account that our study was designed and initiated in 2014. Yet, it must be noted that the 2009 criteria are the most commonly employed criteria for LVDD definition in patients with cirrhosis [8][9][10][11][12]18,[35][36][37][38] enabling the comparison of the results of different studies.…”

Section: Discussionmentioning

confidence: 99%

“…Cirrhotic cardiomyopathy has received great attention the last 20 years and is characterized by systolic and diastolic dysfunction, and electrophysiological abnormalities in the absence of other known causes of cardiac disease [4]. Left ventricular diastolic dysfunction (LVDD) is the most early and prevalent cardiac abnormality, particularly among patients with ascites, while systolic function is usually normal at rest [5].…”

Section: Introductionmentioning

confidence: 99%

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Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Kalambokis,

Christaki,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Left ventricular diastolic dysfunction (LVDD) is the predominant cardiac abnormality in cirrhosis. We investigated the association of LVDD with systemic inflammation and its impact on renal function, occurrence of hepatorenal syndrome (HRS) and survival in patients with cirrhosis and ascites. We prospectively enrolled 215 patients with cirrhosis and ascites. We evaluated the diagnosis and grading of LVDD by Doppler echocardiography, inflammatory markers, systemic hemodynamics, vasoactive factors, radioisotope-assessed renal function and blood flow, HRS development and liver-related mortality. LVDD was diagnosed in 142 (66%) patients [grade 2/3: n = 61 (43%)]. Serum lipopolysaccharide-binding protein (LBP), plasma renin activity (PRA) and glomerular filtration rate (GFR) were independently associated with the presence of grade 2/3 LVDD and the severity of diastolic dysfunction. Serum tumor necrosis factor-α, cardiac output and plasma noradrenaline were also independently associated with the presence of grade 2/3 LVDD. The diastolic function marker E/e′ was strongly correlated with serum LBP (r = 0.731; P < 0.001), PRA (r = 0.714; P < 0.001) and GFR (r = −0.609; P < 0.001) among patients with LVDD. The 5-year risk of HRS development and death was significantly higher in patients with grade 2/3 LVDD compared to those with grade 1 (35.5 vs. 14.4%; P = 0.01 and 53.3 vs. 28.2%; P = 0.03, respectively). The occurrence and severity of LVDD in patients with cirrhosis and ascites is closely related to inflammatory activity. Advanced LVDD is associated with baseline circulatory and renal dysfunction, favoring HRS development, and increased mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Kalambokis,

Christaki,

Tsiakas

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“…The WCG criteria emphasize the blunted cardiac response to exercise, volume challenge, or pharmacological stimuli, whereas the CCC criteria are based on contractile function at rest (Table 1). Nevertheless, the newer CCC criteria appear superior [3,4] and should be used going forward. Although CCM has been investigated extensively, the management is still not standardized because there is no clearly-accepted specific treatment.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Liu,

Ryu,

Hwang

et al. 2024

IJMS

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Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction associated with cirrhosis in the absence of pre-existing heart disease. CCM manifests as the enlargement of cardiac chambers, attenuated systolic and diastolic contractile responses to stress stimuli, and repolarization changes. CCM significantly contributes to mortality and morbidity in patients who undergo liver transplantation and contributes to the pathogenesis of hepatorenal syndrome/acute kidney injury. There is currently no specific treatment. The traditional management for non-cirrhotic cardiomyopathies, such as vasodilators or diuretics, is not applicable because an important feature of cirrhosis is decreased systemic vascular resistance; therefore, vasodilators further worsen the peripheral vasodilatation and hypotension. Long-term diuretic use may cause electrolyte imbalances and potentially renal injury. The heart of the cirrhotic patient is insensitive to cardiac glycosides. Therefore, these types of medications are not useful in patients with CCM. Exploring the therapeutic strategies of CCM is of the utmost importance. The present review summarizes the possible treatment of CCM. We detail the current status of non-selective beta-blockers (NSBBs) in the management of cirrhotic patients and discuss the controversies surrounding NSBBs in clinical practice. Other possible therapeutic agents include drugs with antioxidant, anti-inflammatory, and anti-apoptotic functions; such effects may have potential clinical application. These drugs currently are mainly based on animal studies and include statins, taurine, spermidine, galectin inhibitors, albumin, and direct antioxidants. We conclude with speculations on the future research directions in CCM treatment.

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“…CCM significantly reduces life expectancy. The Cirrhotic Cardiomyopathy Consortium in 2019 and the World Congress of Gastroenterology in 2005 enlisted echocardiographic evaluation, especially the diastolic function as one of the criteria of CCM [ 4 ]. Cardiac contractility is compromised due to systolic and diastolic dysfunction (DD) resulting from electrophysiological malfunctioning.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Diastolic Dysfunction as an Indicator of Cirrhotic Cardiomyopathy in Decompensated Chronic Liver Disease

Kumar,

Shikoh,

Rani

2024

Cureus

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Background: The clinical syndrome of cirrhotic cardiomyopathy (CCM) occurs quite frequently in decompensated chronic liver disease (DCLD) patients without any prior incidence. The compromised life expectancy under such conditions was the key that prompted us to conduct this study. Purpose: This study was planned to study the prevalence of diastolic dysfunction in chronic liver disease patients, to understand the diagnostic criteria of left ventricular diastolic dysfunction (LVDD) in cirrhotic patients, and to evaluate its occurrence as an early indicator of CCM. Methods: A hospital-based, cross-sectional study was conducted on 158 patients, admitted to the Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, India, who conformed to our criteria for inclusion and exclusion. The study period was for 18 months. The subjects were clinically and radiologically diagnosed with chronic liver disease. Regression analysis for variables was performed to score the effects of potential variables with outcomes for diastolic dysfunction (DD) prediction. Results: Out of 158 patients, 116 belonged to the age group of 31-60 years, pronouncing age to be a significant factor for LVDD. Fifty-three subjects had serum bilirubin levels >2mg/dL and we found serum bilirubin levels to bear a significant correlation with LVDD by exhibiting a p-value <0.0001. Both the Child-Turcotte-Pugh score class (p-value=0.0180) and QTc (p-value <0.0001) bear significant correlation with the development of LVDD, which is also evident from their area under the curve (AUC) values of 0.64 in the receiver operating characteristic (ROC) curve. Conclusion: Our study concludes that LVDD is an early indicator for assessing the severity of liver cirrhosis in DCLD. The correlation of DCLD with prolonged QTc could predispose patients with DCLD to ventricular arrhythmias. Hence, such patients should undergo serum bilirubin tests, and electrocardiographic checks at regular intervals for early detection, to increase their overall survival rates.

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Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

Cited by 7 publications

References 128 publications

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites

Therapies for Cirrhotic Cardiomyopathy: Current Perspectives and Future Possibilities

Evaluating Diastolic Dysfunction as an Indicator of Cirrhotic Cardiomyopathy in Decompensated Chronic Liver Disease

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