Cirrhotic cardiomyopathy

TY - JOUR

T1 - Cirrhotic cardiomyopathy

AU - Møller, Søren

AU - Henriksen, Jens H

N1 - Copyright 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

PY - 2010/7

Y1 - 2010/7

N2 - Increased cardiac output was first described in patients with cirrhosis more than fifty years ago. Later, various observations have indicated the presence of a latent cardiac dysfunction, which includes a combination of reduced cardiac contractility with systolic and diastolic dysfunction and electrophysiological abnormalities. This syndrome is termed cirrhotic cardiomyopathy. Results of experimental studies indicate the involvement of several mechanisms in the pathophysiology, such as reduced β-adrenergic receptor signal transduction, altered transmembrane currents and electromechanical coupling, nitric oxide overproduction, and cannabinoid receptor activation. Systolic incompetence in patients can be revealed by pharmacological or physical strain and during stressful procedures, such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. Systolic dysfunction has recently been implicated in development of renal failure in advanced disease. Diastolic dysfunction reflects delayed left ventricular filling and is partly attributed to ventricular hypertrophy, subendocardial oedema, and altered collagen structure. The QT interval is prolonged in about half of the cirrhotic patients and it may be normalised by β-blockers. No specific therapy for cirrhotic cardiomyopathy can be recommended, but treatment should be supportive and directed against the cardiac dysfunction. Future research should better describe the prevalence, impact on morbidity and survival, and look for potential treatments.

AB - Increased cardiac output was first described in patients with cirrhosis more than fifty years ago. Later, various observations have indicated the presence of a latent cardiac dysfunction, which includes a combination of reduced cardiac contractility with systolic and diastolic dysfunction and electrophysiological abnormalities. This syndrome is termed cirrhotic cardiomyopathy. Results of experimental studies indicate the involvement of several mechanisms in the pathophysiology, such as reduced β-adrenergic receptor signal transduction, altered transmembrane currents and electromechanical coupling, nitric oxide overproduction, and cannabinoid receptor activation. Systolic incompetence in patients can be revealed by pharmacological or physical strain and during stressful procedures, such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. Systolic dysfunction has recently been implicated in development of renal failure in advanced disease. Diastolic dysfunction reflects delayed left ventricular filling and is partly attributed to ventricular hypertrophy, subendocardial oedema, and altered collagen structure. The QT interval is prolonged in about half of the cirrhotic patients and it may be normalised by β-blockers. No specific therapy for cirrhotic cardiomyopathy can be recommended, but treatment should be supportive and directed against the cardiac dysfunction. Future research should better describe the prevalence, impact on morbidity and survival, and look for potential treatments.

KW - Animals

KW - Baroreflex

KW - Calcium Signaling

KW - Cardiomyopathies

KW - Electrocardiography

KW - Humans

KW - Liver Cirrhosis

KW - Liver Transplantation

KW - Models, Biological

KW - Myocardial Contraction

KW - Myocytes, Cardiac

KW - Receptor, Cannabinoid, CB1

KW - Receptors, Adrenergic, beta

KW - Syndrome

U2 - 10.1016/j.jhep.2010.02.023

DO - 10.1016/j.jhep.2010.02.023

M3 - Journal article

C2 - 20462649

SN - 0168-8278

VL - 53

SP - 179

EP - 190

JO - Journal of Hepatology

JF - Journal of Hepatology

IS - 1

ER -