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Cirrhotic Cardiomyopathy

  • Liver (S Cotler and E Kallwitz, Section Editors)
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Abstract

Purpose of Review

Cirrhotic cardiomyopathy is a syndrome of depressed cardiac function in patients with cirrhosis. We aimed to review the historical background, pathophysiology and pathogenesis, diagnostic definitions, clinical relevance, and management of this syndrome.

Recent Findings

An inflammatory phenotype underlies the pathogenesis: gut bacterial translocation with endotoxemia stimulates cytokines and cardiodepressant factors, such as nitric oxide and endocannabinoids. Cardiomyocyte plasma membrane biochemical and biophysical changes also play a pathogenic role. These factors lead to impaired beta-adrenergic function. Proposed new echocardiographic criteria for the diagnosis of cirrhotic cardiomyopathy include systolic global longitudinal strain and indices of diastolic dysfunction. Cardiac dysfunction participates in the pathogenesis of hepatorenal syndrome and increased morbidity/mortality of cirrhotic patients to hemorrhage, infection, and surgery, including liver transplantation. There is no specific treatment, although β-adrenergic blockade and supportive management have been proposed, but it needs further study.

Summary

Cirrhotic cardiomyopathy is a clinically relevant syndrome afflicting patients with established cirrhosis. Optimum management remains unclear, and further study is needed in this area.

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Author notes

  1. Ki Tae Yoon and Hongqun Liu contributed equally to this paper.

Authors and Affiliations

  1. Liver Unit, University Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada

    Ki Tae Yoon, Hongqun Liu & Samuel S. Lee

  2. Liver Center, Department of Internal Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 50612, South Korea

    Ki Tae Yoon

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SS Lee outlined the sections and revised the draft. KT Yoon and H Liu composed the first draft. All authors read and approved the final version.

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Correspondence to Samuel S. Lee.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Prof. Yoon was the recipient of a sabbatical leave from Pusan National University Yangsan Hospital.

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Yoon, K.T., Liu, H. & Lee, S.S. Cirrhotic Cardiomyopathy. Curr Gastroenterol Rep 22, 45 (2020). https://doi.org/10.1007/s11894-020-00783-1

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