Review article: comprehensive analysis of cirrhotic cardiomyopathy

Abstract

SummaryBackgroundPatients with cirrhosis are at risk of developing cirrhotic cardiomyopathy. This syndrome is unique to cirrhosis and is generally defined as subnormal cardiac function in the absence of prior heart disease. There is no systematic or comprehensive review of cirrhotic cardiomyopathy to date.AimsTo comprehensively review the literature on the definition, pathogenic mechanisms, diagnostic criteria, prevalence, management and influence on liver transplantation including reversibility of cirrhotic cardiomyopathy.MethodsElectronic searches of the EMBASE, MEDLINE, EBM Reviews—Cochrane Central Register of Controlled Trials, EBM Reviews—Cochrane Database of Systematic Reviews and Google Scholar databases were conducted. MeSH terms focused on cirrhosis, cardiomyopathy, medication classes and epidemiology. Literature up to August 2020 was reviewed.ResultsNew diagnostic criteria for the definition of cirrhotic cardiomyopathy have recently been published, consisting of systolic and diastolic dysfunction parameters as assessed by echocardiographic methods. The roles of electrocardiographic disturbances and biomarkers in the definition criteria remain unclear. Pathogenic mechanisms underlying cirrhotic cardiomyopathy are likely related to the inflammatory phenotype of cirrhosis. Prevalence rates of 26%‐81% in cirrhotic patients are reported. Several medical therapies have been proposed, but none with clear evidence of efficacy. The presence of cirrhotic cardiomyopathy complicates the liver transplantation process with a higher risk of adverse cardiovascular events post‐transplant. Complete reversibility of the syndrome after transplantation remains controversial but most studies suggest that it does not occur at least within the first post‐operative year.ConclusionsCirrhotic cardiomyopathy is a clinically relevant syndrome that affects morbidity and mortality in patients with cirrhosis.

Cardiomiopatía cirrótica – ¿Realidad clínica o simple curiosidad académica? Revisión.

“…Debido a la naturaleza latente de la CMC es difícil establecer con precisión su prevalencia. Chahal y col registraron una prevalencia variable entre 26-81%; 12 Shahvaran y col en un metanálisis de 12 estudios siguiendo los criterios de Montreal 2005, encontraron que la prevalencia definida por ecocardiograma 2D (Eco 2D) fue de 61%, mientras que fue 45% cuando se utilizaron criterios de imágenes de doppler tisular (TDI), es decir que las imágenes aisladas de Eco2D podrían sobrediagnosticar CMC. 13 Cesari y col usando los criterios de 2020, encontraron una prevalencia con strain longitudinal global (SLG) anormal en 25% de los pacientes y disfunción diastólica avanzada en 10%.…”

Cardiomyopathy in cirrhosis: From pathophysiology to clinical care

“…with oxygen therapy, sodium restriction, and diuretics. 105 Besides reducing the risk of bleeding from oesophageal varices, 106 β-blockers alleviate systemic inflammation by reducing portal pressure, mesenteric venous congestion and intestinal permeability, thereby reducing the entry of inflammatory cytokines into the circulation. The alleviation of systemic inflammation may benefit the heart.…”

“…There is relatively little literature on transplantation correcting CCM but current evidence suggests that this is indeed the case. 105 However, a detailed discussion of transplantation is beyond the scope of this review. 79 …”

Review article: Evaluation and care of the critically ill patient with cirrhosis

“…13 Patients with sepsis or systemic inflammation have circulatory dysfunction secondary to inflammatory mediators like nitric oxide (NO), endotoxin, interleukins (Il-1, and Il-6) and tumour necrosis factor α (TNF α). 16,17 Further, patients with CCM fail to augment the cardiac output in response to critical illnesses like sepsis, exercise and surgery, 13,18 which in turns impairs tissue perfusion and contributes to secondary organ failures.…”