Therapy Insight: cirrhotic cardiomyopathy

Gaskari, Seyed Ali; Honar, Hooman; Lee, Samuel S.

doi:10.1038/ncpgasthep0498

Cited by 124 publications

(104 citation statements)

References 57 publications

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“…These findings also introduce new considerations on the potential role of drugs such as beta blockers, angiotensin II receptor antagonists and aldosterone antagonists: their therapeutic application in earlier stages of the cirrhotic disease might prove useful in the clinical management of cirrhotic cardiomyopathy before decompensation of disease develops [63][64][65].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…These changes are associated with extensive arteriovenous communications and release of systemic vasodilators, such as glucagon, nitric oxide, ferritin, and vasoactive intestinal polypeptide. 1 Severe pulmonary hypertension or intrapulmonary arteriovenous shunts also occur in such patients. 2 Severe pulmonary hypertension is a contraindication to liver transplantation.…”

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confidence: 99%

Incidence of severe ventricular arrhythmias during pulmonary artery catheterization in liver allograft recipients

Gwak

Kim

et al. 2007

Liver Transpl

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Liver allograft recipients may develop a hyperdynamic circulation and cardiac electrophysiologic abnormalities. The incidence of severe ventricular arrhythmias in liver allograft recipients during pulmonary artery (PA) catheterization was determined. One hundred five liver allograft recipients were studied prospectively; 5 of the patients with preexisting valvular heart disease, ischemic heart disease, or arrhythmias were excluded. Severe ventricular arrhythmia, defined as 3 or more consecutive ventricular premature beats occurring at a rate of Ͼ100 per minute, was observed in 37.0% of the patients during insertion of the catheter and in 25.0% of the patients during removal of the catheter. Two patients developed ventricular tachycardia, and 2 developed ventricular fibrillation; the arrhythmias in these 4 patients did not respond to appropriate pharmacological treatment but resolved promptly after removal of the PA catheter. The catheter transit time from the right ventricle to the pulmonary capillary wedge position was longer in patients with severe ventricular arrhythmia than in those without this arrhythmia (91.6 Ϯ 103. Liver transplantation is commonly associated with the administration of large volumes of fluid and massive hemorrhaging; predisposing factors include abnormalities of blood coagulation, the presence of numerous collateral vessels, and prolonged periods of surgery. Patients with end-stage chronic liver disease have a hyperdynamic circulation, features of which include increased cardiac output, tachycardia, and decreased systemic vascular resistance (SVR). These changes are associated with extensive arteriovenous communications and release of systemic vasodilators, such as glucagon, nitric oxide, ferritin, and vasoactive intestinal polypeptide. 1 Severe pulmonary hypertension or intrapulmonary arteriovenous shunts also occur in such patients. 2 Severe pulmonary hypertension is a contraindication to liver transplantation. Assessments of ventricular function are required throughout this procedure. Accordingly, in most centers, a pulmonary artery (PA) catheter is inserted routinely to evaluate cardiac function. The development of arrhythmias during the insertion of a PA catheter in patients undergoing cardiovascular surgery has been reported 3,4 (Fig. 1). However, the incidence of arrhythmias and hemodynamic changes in relation to the placement of a PA catheter in liver allograft recipients is unknown. Our experience with such patients suggests that the development of an arrhythmia commonly occurs during the insertion and removal of the catheter. The aim of this study was to examine prospectively arrhythmias and hemodynamic changes associated with PA catheterization in liver allograft recipients and to investigate possible factors responsible for these complications. PATIENTS AND METHODSThis study was approved by the local institutional review board on human studies; informed consent was

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“…Literature reports have shown a relation between systemic blood pressure levels and the type of postoperative outcome 1,4 . Patients with low arterial blood pressure, due to the systemic vasodilation mentioned above, have a postoperative outcome involving greater morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with cirrhosis of the liver course with a hyperdynamic systemic circulation, manifested by an increased cardiac output and decreased peripheral vascular resistance and arterial pressure 1 . These changes intensify with disease progression and are reversible with liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Analysis of 83 consecutive liver transplants performed at a tertiary care reference hospital in the interior of the state of Sao Paulo

Lombardi¹,

Mente²,

Sankarankutty³

et al. 2011

Acta Cir. Bras.

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PURPOSE:To analyze pre-, intra-and immediate postoperative parameters of patients submitted to liver transplantation. METHODS: Eighty-three consecutive orthotopic liver transplants performed from January 2009 to July 2011 were analyzed. The patients were divided into 2 groups: A, survivors (MELD between 9 and 60) and B, non-survivors (MELD between 14 and 40), with 30.6% of group A patients being CHILD C, 51℅ CHILD B and 18,4℅ CHILD A. In group B ,32.1℅ of the patients were CHILD C, 42,9℅ CHILD B, and 25℅ CHILD A. All orthotopic liver transplantations were performed using the piggyback technique without a portacaval shunt. Systemic arterial pressure and serum ALT and AST levels were determined preoperatively and 5, 60 and 1440 minutes after arterial graft revascularization. Serum ALT and AST profiles were evaluated for seven days after surgery. RESULTS: Systemic arterial blood pressure levels, time of hot and hypothermic ischemia and time of graft implant were statistically similar for the two groups (p>0.05). Serum levels (U/L) of ALT and AST at the 5, 60 and 1440 minute time points after arterial revascularization of the graft were also similar for the two groups studied, as also were the serum ALT and AST profiles. CONCLUSIONS: No statistically significant difference in any of the parameters studied was detected between the two groups. Under the conditions of the present study and on the basis of the parameters evaluated, no direct relation was detected between the intraoperative period and the type of patient outcome in the two groups studied. Keywords: Liver Transplantation. Transaminases. Blood Pressure. Todos os transplantes ortotópicos de fígado foram feitos com a técnica de piggyback sem "shunt" porto cava. Foram analisados os valores de pressão arterial sistêmica e os níveis séricos de ALT e AST, no pré-operatório, 5, 60 e 1440 minutos após revascularização arterial do enxerto. Avaliaram-se os perfis séricos da ALT e AST durante sete dias de pós-operatorio. RESULTADOS: Verificou-se que em ambos os grupos, os níveis de pressão arterial sistêmica, os tempos de isquemia normotérmica, hipotérmica e de implante do enxerto foram estatisticamente semelhantes (p>0,05). Os níveis séricos (U/L) de ALT e AST nos tempos de 5, 60 e 1440 minutos após a revascularização arterial do enxerto também foram semelhantes nos grupos estudados. Os perfis séricos da ALT e AST foram semelhantes nos dois grupos estudados. CONCLUSÕES: Não se verificou diferença estatisticamente significante entre todos os parâmetros estudados, em ambos os grupos. Nas condições do presente estudo, não se verificou relação direta do intra-operatório com o tipo de evolução (outcome) dos pacientes nos dois grupos estudados. Descritores: Transplante de Fígado. Transaminases. Pressão Arterial. Analysis of 83 consecutive liver transplants performed at a tertiary care reference hospital in the interior of the State of Sao PauloActa Cirúrgica Brasileira -Vol. 26 (6) 2011 -531

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Therapy Insight: cirrhotic cardiomyopathy

Cited by 124 publications

References 57 publications

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

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

Incidence of severe ventricular arrhythmias during pulmonary artery catheterization in liver allograft recipients

Analysis of 83 consecutive liver transplants performed at a tertiary care reference hospital in the interior of the state of Sao Paulo

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