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Recent Advances in Cirrhotic Cardiomyopathy

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Abstract

Cirrhotic cardiomyopathy, a cardiac dysfunction presented in patients with cirrhosis, represents a recently recognized clinical entity. It is characterized by altered diastolic relaxation, impaired contractility, and electrophysiological abnormalities, in particular prolongation of the QT interval. Several mechanisms seem to be involved in the pathogenesis of cirrhotic cardiomyopathy, including impaired function of beta-receptors, altered transmembrane currents, and overproduction of cardiodepressant factors, like nitric oxide, tumor necrosis factor α, and endogenous cannabinoids. Diastolic dysfunction is the first manifestation of cirrhotic cardiomyopathy and reflects the increased stiffness of the cardiac mass, which leads to delayed left ventricular filling. On the other hand, systolic incompetence is presented later, is usually unmasked during pharmacological or physical stress, and predisposes to the development of hepatorenal syndrome. The prolongation of QT is found in about 50 % of cirrhotic patients, but rarely leads to fatal arrhythmias. Cirrhotics with blunted cardiac function seem to have poorer survival rates compared to those without, and the risk is particularly increased during the insertion of transjugular intrahepatic portosystemic shunt or liver transplantation. Till now, there is no specific treatment for the management of cirrhotic cardiomyopathy. New agents, targeting to its pathogenetical mechanisms, may play some role as future therapeutic options.

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Abbreviations

HRS:

Hepatorenal syndrome

CC:

Cirrhotic cardiomyopathy

TIPS:

Transjugular intrahepatic portosystemic shunt

NO:

Nitric oxide

TNF-α:

Tumor necrosis α

IL-1 β:

Interleukin 1 β

iNOs:

Inducible nitric oxide synthetase

l-NAME:

l-Nitro-arginine methyl ester

BDL:

Bile duct ligation

CB1:

Cannabinoid 1

LBP:

Lipopolysaccharide binding protein

DD:

Diastolic dysfunction

TDI:

Tissue doppler imaging

LT:

Liver transplantation

CO:

Cardiac output

EF:

Ejection fraction

SD:

Systolic dysfunction

HR:

Heart rate

CI:

Cardiac index

SBP:

Spontaneous bacterial peritonitis

BNP:

Brain natriuretic peptide

HVPG:

Hepatic venous pressure gradient

MAP:

Mean arterial pressure

HSA:

Human serum albumin

NF-κB:

Nuclear factor kappa B

EPO:

Erythropoietin

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Acknowledgments

The guarantor of this paper is Assistant Professor Dr. Jiannis Vlachogiannakos. Dimitrios S. Karagiannakis has taken over the planning, concept design, data analysis, as well as the review write up. For the study design, as well as data interpretation, Associate Professor George Papatheodoridis was also involved.

Conflict of interest

All the authors have approved the final draft submitted to this journal with nothing to disclose, regarding funding or conflict of interest.

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  1. Department of Gastroenterology, Medical School of Athens University, Laiko General Hospital, 17 Agiou Thoma Street, 11527, Athens, Greece

    Dimitrios S. Karagiannakis, George Papatheodoridis & Jiannis Vlachogiannakos

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  1. Dimitrios S. Karagiannakis
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Correspondence to Dimitrios S. Karagiannakis.

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Karagiannakis, D.S., Papatheodoridis, G. & Vlachogiannakos, J. Recent Advances in Cirrhotic Cardiomyopathy. Dig Dis Sci 60, 1141–1151 (2015). https://doi.org/10.1007/s10620-014-3432-8

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