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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Format: | Article |
Language: | English |
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MDPI AG
2021-02-01
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Series: | Gastroenterology Insights |
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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advances in cardiovascular imaging and in particular myocardial deformation imaging have rendered the WCG criteria outdated.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. |
first_indexed | 2024-03-09T00:31:53Z |
format | Article |
id | doaj.art-d54732447d2f40d4b9a98e8e0c5dae1a |
institution | Directory Open Access Journal |
issn | 2036-7414 2036-7422 |
language | English |
last_indexed | 2024-03-09T00:31:53Z |
publishDate | 2021-02-01 |
publisher | MDPI AG |
record_format | Article |
series | Gastroenterology Insights |
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 |