Cardiomyopathy in cirrhosis: from pathophysiology to clinical care

نویسندگان

چکیده

Cirrhotic cardiomyopathy (CCM) is defined as systolic or diastolic dysfunction in the absence of prior heart disease other identifiable cause patients with cirrhosis and an important determinant outcome. Its underlying pathogenic/pathophysiological mechanisms are rooted two distinct pathways: 1) factors associated portal hypertension, hyperdynamic circulation gut bacterial/endotoxin translocation inflammatory phenotype. 2) Hepatocellular insufficiency altered synthesis metabolism substances such proteins, lipids, carbohydrates, bile acids hormones. Different criteria have been proposed to diagnose CCM; first 2005 by World Congress Gastroenterology (WCG), more recently 2019 Cardiomyopathy Consortium (CCC). These mainly utilized echocardiographic evaluation, latter refining function evaluation introducing global longitudinal strain evaluate function, addition since hemodynamic changes that occur advanced may lead overestimation left ventricular ejection fraction. Advances cardiac imaging magnetic resonance incorporating exercise challenge help further refine diagnosis CCM. Clinical implications cirrhotic elucidated over past decades include contributing increased mortality morbidity after major interventions liver transplantation TIPS stent insertion, a pathophysiologic role genesis hepatorenal syndrome. In this review, we discuss pathogenesis/pathophysiology, modalities including MRI, comparison WCG CCC criteria, electrocardiographic QT prolongation clinical implications. At present, no definitive medical therapy exists, but some promising potential treatment strategies for CCM reviewed.

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ژورنال

عنوان ژورنال: JHEP reports

سال: 2023

ISSN: ['2589-5559']

DOI: https://doi.org/10.1016/j.jhepr.2023.100911