The heart and the liver

Abstract

Cardiac failure affects the liver and liver dysfunction affects the heart. Chronic and acute heart failure can lead to cardiac cirrhosis and cardiogenic ischemic hepatitis. These conditions may impair liver function and treatment should be directed towards the primary heart disease and seek to secure perfusion of vital organs. In patients with advanced cirrhosis, physical and/or pharmacological stress may reveal a reduced cardiac performance with systolic and diastolic dysfunction and electrophysical abnormalities, termed cirrhotic cardiomyopathy. Pathophysiological mechanisms include reduced beta-adrenergic receptor signal transduction and defective cardiac electromechanical coupling. However, the QT interval is prolonged in approximately half of patients with cirrhosis and it may be improved by beta-blockers. No specific therapy can be recommended but it should be supportive and directed against the heart failure. Transjugular intrahepatic portosystemic shunt insertion and liver transplantation affect cardiac function in portal hypertensive patients and cause stress to the cirrhotic heart, with a risk of perioperative heart failure. The risk and prevalence of coronary artery disease are increasing in cirrhotic patients and since perioperative mortality is high, careful evaluation of such patients with dobutamine stress echocardiography, coronary angiography and myocardial perfusion imaging is required prior to liver transplantation. Future research should focus on beneficial effects of treatment on cardiac function and mortality.

A study of cardiovascular abnormalities among cirrhosis of liver cases

“…Studies have proven that there is E/A normalization in patients that receive liver transplant. 10 The difference in this study was statistically significant. LVEF was normal in 148 of the patients of the study group, with mean value of 64.53±0.97%, similar to results in same above mentioned studies.…”

A Clinical Study on Cardiovascular Manifestations Secondary to Cirrhosis of Liver

“…LVEF was normal in most of the patients of the study group with mean value of 55.73 ± 0.97%, similar to results in below mentioned studies. This paradoxical normal EF value in the face of diastolic dysfunction could probably be because of normal pre and after load of the cirrhotic heart as explained by Moller et al [5] …”

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

“…However, after the introduction of the MELD score as a criterion for prioritization in the transplant waiting list, more severe patients and those with more comorbidities were prioritized for indication and performance of surgery 105,106 . Also, the indication for transplantation in patients older than 50 years has been increasingly frequent [107][108][109] , and with increasing life expectancy, these patients tend to develop or complicate coronary artery disease more often than the population the same age and sex 108,110,111 .…”

“…Before surgery, some patients undergo passage of transjugular intrahepatic portosystemic shunt (TIPS), resulting in increased venous flow and ventricular hypertrophy, which may cause pulmonary edema and decompensation during the perioperative period 106 .…”

“…Usually electrocardiogram and chest X-ray are included in the preoperative routine of these patients. In almost 50% of the patients, the QT interval is extended, it tends to improve with the use of beta-blockers, but no specific therapy has proven beneficial 106,117 .…”