Hepatorenal Syndrome: Circulatory Changes

The syndrome of cirrhotic cardiomyopathy, first recognized in 1969 but mistakenly presumed to reflect latent alcoholic cardiomyopathy in patients with alcoholic cirrhosis, is now recognized to occur in all forms of cirrhosis, alcoholic and non-alcoholic, and thus is associated with cirrhosis per se. The hallmark of the syndrome is normal or increased ventricular contractility at rest, but depressed responsiveness to stimuli. In the past decade, many studies have demonstrated the clinical significance of this syndrome, from cardiac decompensation after surgery, cardiovascular procedures, therapeutic interventions targeted to manage the decompensated phase of cirrhosis and liver transplantation. Recent studies indicate that cirrhotic cardiomyopathy plays a key pathogenic role in hepatorenal syndrome. Indeed the past decade has seen an explosion of interest and awareness of this syndrome1.