Cirrhotic Cardiomyopathy

Cirrhotic cardiomyopathy (CCM), cardiac dysfunction in end-stage liver disease in the absence of prior heart disease, is an important clinical entity that contributes significantly to morbidity and mortality. The original definition for CCM, established in 2005 at the World Congress of Gastroenterol...

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Main Authors: Kieran Longley, Tuan Tran, Vincent Ho
Format: Article
Language:English
Published: MDPI AG 2021-02-01
Series:Gastroenterology Insights
Subjects:
Online Access:https://www.mdpi.com/2036-7422/12/1/8
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author Kieran Longley
Tuan Tran
Vincent Ho
author_facet Kieran Longley
Tuan Tran
Vincent Ho
author_sort Kieran Longley
collection DOAJ
description Cirrhotic cardiomyopathy (CCM), cardiac dysfunction in end-stage liver disease in the absence of prior heart disease, is an important clinical entity that contributes significantly to morbidity and mortality. The original definition for CCM, established in 2005 at the World Congress of Gastroenterology (WCG), was based upon known echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Subsequent advances in cardiovascular imaging and in particular myocardial deformation imaging have rendered the WCG criteria outdated. A number of investigations have explored other factors relevant to CCM, including serum markers, electrocardiography, and magnetic resonance imaging. CCM characteristics include a hyperdynamic circulatory state, impaired contractility, altered diastolic relaxation, and electrophysiological abnormalities, particularly QT interval prolongation. It is now known that cardiac dysfunction worsens with the progression of cirrhosis. Treatment for CCM has traditionally been limited to supportive efforts, but new pharmacological studies appear promising. Left ventricular diastolic dysfunction in CCM can be improved by targeted heart rate reduction. Ivabradine combined with carvedilol improves left ventricular diastolic dysfunction through targeted heart rate reduction, and this regimen can improve survival in patients with cirrhosis. Orthotopic liver transplantation also appears to improve CCM. Here, we canvass diagnostic challenges associated with CCM, introduce cardiac physiology principles and the application of echocardiographic techniques, and discuss the evidence behind therapeutic interventions in CCM.
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spelling doaj.art-d54732447d2f40d4b9a98e8e0c5dae1a2023-12-11T18:27:33ZengMDPI AGGastroenterology Insights2036-74142036-74222021-02-01121768810.3390/gastroent12010008Cirrhotic CardiomyopathyKieran Longley0Tuan Tran1Vincent Ho2School of Medicine, Western Sydney University, Campbelltown, NSW 2560, AustraliaSchool of Medicine, Western Sydney University, Campbelltown, NSW 2560, AustraliaSchool of Medicine, Western Sydney University, Campbelltown, NSW 2560, AustraliaCirrhotic cardiomyopathy (CCM), cardiac dysfunction in end-stage liver disease in the absence of prior heart disease, is an important clinical entity that contributes significantly to morbidity and mortality. The original definition for CCM, established in 2005 at the World Congress of Gastroenterology (WCG), was based upon known echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Subsequent advances in cardiovascular imaging and in particular myocardial deformation imaging have rendered the WCG criteria outdated. A number of investigations have explored other factors relevant to CCM, including serum markers, electrocardiography, and magnetic resonance imaging. CCM characteristics include a hyperdynamic circulatory state, impaired contractility, altered diastolic relaxation, and electrophysiological abnormalities, particularly QT interval prolongation. It is now known that cardiac dysfunction worsens with the progression of cirrhosis. Treatment for CCM has traditionally been limited to supportive efforts, but new pharmacological studies appear promising. Left ventricular diastolic dysfunction in CCM can be improved by targeted heart rate reduction. Ivabradine combined with carvedilol improves left ventricular diastolic dysfunction through targeted heart rate reduction, and this regimen can improve survival in patients with cirrhosis. Orthotopic liver transplantation also appears to improve CCM. Here, we canvass diagnostic challenges associated with CCM, introduce cardiac physiology principles and the application of echocardiographic techniques, and discuss the evidence behind therapeutic interventions in CCM.https://www.mdpi.com/2036-7422/12/1/8cirrhosiscardiomyopathyechocardiographytreatmentdiagnosispathophysiology
spellingShingle Kieran Longley
Tuan Tran
Vincent Ho
Cirrhotic Cardiomyopathy
Gastroenterology Insights
cirrhosis
cardiomyopathy
echocardiography
treatment
diagnosis
pathophysiology
title Cirrhotic Cardiomyopathy
title_full Cirrhotic Cardiomyopathy
title_fullStr Cirrhotic Cardiomyopathy
title_full_unstemmed Cirrhotic Cardiomyopathy
title_short Cirrhotic Cardiomyopathy
title_sort cirrhotic cardiomyopathy
topic cirrhosis
cardiomyopathy
echocardiography
treatment
diagnosis
pathophysiology
url https://www.mdpi.com/2036-7422/12/1/8
work_keys_str_mv AT kieranlongley cirrhoticcardiomyopathy
AT tuantran cirrhoticcardiomyopathy
AT vincentho cirrhoticcardiomyopathy