Perioperative considerations in patients with cirrhotic cardiomyopathy

Biancofiore, Gianni; Mandell, M. Susan; Rocca, Giorgio Della

doi:10.1097/aco.0b013e328337260a

Cited by 22 publications

(25 citation statements)

References 51 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It provides the added benefit of real time assessment of the response to fluid, direct visualisation of global and regional myocardial performance and detection of air and thromboembolism [81] . In addition, it can allow an earlier visual detection of right ventricular failure, as the substantial compliance of the right ventricle allows significant dilation before any pressure changes that would be detected with a PAFC [82] .…”

Section: Haemodynamic Monitoringmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

View full text Add to dashboard Cite

Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

show abstract

Section: Haemodynamic Monitoringmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

View full text Add to dashboard Cite

show abstract

“…Although cardiac complications are usually seen in patients with more advanced liver disease, adverse cardiac outcomes can still occur in patients who are not as ill [20] and overt manifestations of cardiovascular dysfunction often only become evident after a cirrhotic patient is exposed to physiological, surgical or drug-induced stress. In this context, PRAM methodology appears, according to our data, able to detect cardiovascular alterations in cirrhotic patients, both at rest and during postural change, by means of a bedside non invasive evaluation.…”

Section: Discussionmentioning

confidence: 99%

Non invasive continuous hemodynamic evaluation of cirrhotic patients after postural challenge

Tarquini

Mazzoccoli

Fusi³

et al. 2012

WJH

View full text Add to dashboard Cite

AIM:To assess whether Most Care is able to detect the cardiovascular alterations in response to physiological stress (posture). METHODS:Non invasive hemodynamic was assessed in 26 cirrhotic patients compared to healthy subjects, both in the supine and standing positions. RESULTS:In baseline conditions, when compared to healthy subjects, cirrhotic patients showed significantly lower values of dicrotic and diastolic pressures and systemic vascular resistance. While in the standing position, cirrhotic patients showed higher values of cardiac index, stroke volume index and cardiac cycle efficiency. When returning to the supine position, cirrhotic patients exhibited lower values of dicrotic and diastolic pressures and systemic vascular resistance in the presence of higher values of cardiac index, stroke volume index and cardiac cycle efficiency.CONCLUSION: Most Care proved to be able to detect cardiovascular abnormalities bedside in the resting state and after postural challenge in cirrhotic patients.

show abstract

“…However, it is generally thought that they can be unveiled by stress conditions, such as physical exercise, bleeding, infections and major surgery. Ventricular diastolic dysfunction and electrophysiological abnormalities such as chronotropic incompetence and a prolonged QT interval also are demonstrated in cirrhotic patients [ 15 ]. Systemic conditions such as haemochromatosis (ventricular hypertrophy with increased end-diastolic and endsystolic volumes), amyloidosis (restrictive cardiomyopathy), Wilson's disease (supraventricular extrasytolic beats) and alcoholism (systolic and diastolic dysfunction) can affect liver and cardiac function [ 16 ].…”

Section: Cardiovascular Systemmentioning

confidence: 99%

Anaesthetic and Perioperative Management for Liver Transplantation

Siniscalchi

Pierucci

Faenza

2015

Abdominal Solid Organ Transplantation

View full text Add to dashboard Cite

Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insuffi ciency and/or portal systemic shunt (PSS); it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma [ 1 -3 ]. The pathogenesis of hepatic encephalopathy is not completely understood, but most theories implicate elevated levels of ammonia, a gut-derived neurotoxin, which is shunted to the systemic circulation from the portal system [ 4 ]. Computed tomography, magnetic resonance or other imaging techniques do not contribute to the diagnosis or to the staging of the pathology [ 5 ]. However, the risk of intracerebral haemorrhage is at least fi vefold increased in this patient population [ 6 ], and the symptoms may be indistinguishable; hence, a brain scan is usually part of the diagnostic workup of patients developing HE for the fi rst time and on clinical suspicion of other pathologies [ 5 , 7 -9 ].Patients who develop fulminant hepatic failure are at risk for hepatic encephalopathy, cerebral oedema with increased intracranial pressure (ICP) and herniation. In cases of altered mental status, a head CT scan is often indicated to evaluate intracranial bleeding, herniation, the extent of cerebral oedema or both.

show abstract

Perioperative considerations in patients with cirrhotic cardiomyopathy

Cited by 22 publications

References 51 publications

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Non invasive continuous hemodynamic evaluation of cirrhotic patients after postural challenge

Anaesthetic and Perioperative Management for Liver Transplantation

Contact Info

Product

Resources

About