Skip to main content
SpringerLink
Log in

Cirrhotic Cardiomyopathy

  • Chapter
  • First Online:
Liver Diseases

Abstract

Liver cirrhosis (LC) is an important cause of mortality in adults. Access to liver transplant (LT) has improved significantly the prognosis of this disease. Cardiac dysfunction is considered the main cause of mortality after LT. However, the most updated pre-LT evaluation guideline provides only an algorithm for the evaluation of major cardiovascular diseases, without giving any clear recommendations for cirrhotic cardiomyopathy (CCM).

CCM is defined as a cardiac dysfunction that includes impaired cardiac contractility, with subclinical systolic and diastolic dysfunction, electromechanical abnormalities associated with augmented vascular function, in the absence of other known causes of cardiac disease. CCM contributes to various complications in cirrhosis, especially in the development of heart failure in relation to invasive procedures, surgical intervention, and LT. Its diagnosis is based mostly on conventional echocardiography, revealing mainly diastolic dysfunction. The roles of new methods, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in the diagnosis and prognosis of CCM remain controversial. These methods might be essential in early detection and better definition of cardiac dysfunction in presumed high preload conditions. However, they are not yet included in the CCM diagnosis algorithm. Furthermore, measurement of circulating levels of cardiac biomarkers could improve the diagnostic assessment. Current pharmacological treatment is nonspecific and liver transplantation is the only potential treatment with specific effect on CCM. The therapeutic options should follow the recommendations for the treatment of liver cirrhosis and heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59:1144–65.

    Article  PubMed  Google Scholar 

  2. Mocarzel LOC, Rossi MM, Miliosse B de M, Lanzieri PG, Gismondi RA. Cirrhotic cardiomyopathy: a new clinical phenotype. Arq Bras Cardiol. 2017;108:564–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Zaky A, Bendjelid K. Appraising cardiac dysfunction in liver transplantation: an ongoing challenge. Liver Int. 2015;35:12–29.

    Article  PubMed  Google Scholar 

  4. Møller S, Hove JD, Dixen U, Bendtsen F. New insights into cirrhotic cardiomyopathy. Int J Cardiol. 2013;167:1101–8.

    Article  PubMed  Google Scholar 

  5. Merli M, Calicchia A, Ruffa A, Pellicori P, Riggio O, Giusto M, et al. Cardiac dysfunction in cirrhosis is not associated with the severity of liver disease. Eur J Intern Med. 2013;24:172–6.

    Article  PubMed  Google Scholar 

  6. Nazar A, Guevara M, Sitges M, Terra C, Solà E, Guigou C, Arroyo V, Ginès P. Left ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamic and renal dysfunction. J Hepatol. 2013;58:51–7.

    Article  PubMed  Google Scholar 

  7. Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, et al. Systolic and diastolic dysfunction in cirrhosis: a tissue-Doppler and speckle tracking echocardiography study. Liver Int. 2013;33:1158–65.

    Article  CAS  PubMed  Google Scholar 

  8. Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, et al. Systolic dysfunction and diastolic dysfunction do not influence medium-term prognosis in patients with cirrhosis. Eur J Intern Med. 2014;25:241–6.

    Article  PubMed  Google Scholar 

  9. Naqvi IH, Mahmood K, Naeem M, Vashwani AS, Ziaullah S. The heart matters when the liver shatters! Cirrhotic cardiomyopathy: frequency, comparison, and correlation with severity of disease. Gastroenterol Rev. 2016;11:247–56.

    Article  CAS  Google Scholar 

  10. Enache I, Oswald-Mammosser M, Woehl-Jaegle M-L, Habersetzer F, Di MP, Charloux A, Doutreleau S. Cirrhotic cardiomyopathy and hepatopulmonary syndrome: Prevalence and prognosis in a series of patients. Respir Med. 2013;107:1030–6.

    Article  PubMed  Google Scholar 

  11. Gassanov N, Caglayan E, Semmo N, Massenkeil G, Er F. Cirrhotic cardiomyopathy: a cardiologist’s perspective. World J Gastroenterol. 2014;20:15492–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wiese S, Hove JD, Bendtsen F, Møller S. Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol. 2014;11:177–86.

    Article  CAS  PubMed  Google Scholar 

  13. Horvatits T, Drolz A, Rutter K, Roedl K, Kluge S, Fuhrmann V. Hepato-cardiac disorders. World J Hepatol. 2014;6:41–54.

    Article  Google Scholar 

  14. Møller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34:2804–11.

    Article  PubMed  Google Scholar 

  15. Mota VG, Markman Filho B. Echocardiography in chronic liver disease: systematic review. Arq Bras Cardiol. 2013;100:376–85.

    PubMed  Google Scholar 

  16. Liu H, Jayakumar S, Traboulsi M, Lee SS. Cirrhotic cardiomyopathy: implications for liver transplantation. Liver Transpl. 2017;23:826–35.

    Article  PubMed  Google Scholar 

  17. Nagueh SF, Smiseth OA, Appleton CP, Benjamin F, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277–314.

    Article  PubMed  Google Scholar 

  18. Rimbaş RC, Baldea SM, Guerra RDGA, Visoiu SI, Rimbaş M, Pop CS, Vinereanu D. New definition criteria of myocardial dysfunction in patients with liver cirrhosis: a speckle tracking and tissue Doppler imaging study. Ultrasound Med Biol. 2018;44:562–74.

    Article  PubMed  Google Scholar 

  19. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.

    Article  PubMed  Google Scholar 

  20. Sampaio F, Lamata P, Bettencourt N, Alt SC, Ferreira N, Kowallick JT, et al. Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy. J Cardiovasc Magn Reson. 2015;17:61.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Altekin RE, Caglar B, Karakas MS, Ozel D, Deger N, Demir I. Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle-tracking echocardiography in patients with non-alcoholic cirrhosis. Hell J Cardiol. 2014;55:402–10.

    Google Scholar 

  22. Izzy M, Oh J, Watt KD. Cirrhotic cardiomyopathy after transplantation: neither the transient nor innocent bystander. Hepatology. 2018; https://doi.org/10.1002/hep.30040.

    Article  PubMed  Google Scholar 

  23. Chen Y, Chan AC, Chan SC, Chok SH, Sharr W, Fung J, Liu JH, et al. A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation. J Cardiol. 2016;67:140–6.

    Article  PubMed  Google Scholar 

  24. Naqvi IH, Mahmood K, Talib A, Rizvi NZ. Looking beyond liver! cirrhotic cardiomyopathy: pathophysiology, clinical presentation and management strategies. J Gastroenterol Liv Pancr Dis. 2017;2:1009.

    Google Scholar 

  25. Carvalheiro F, Rodrigues C, Adrego T, Viana J, Vieira H, Seco C, et al. Diastolic dysfunction in liver cirrhosis: prognostic predictor in liver transplantation? Transplant Proc. 2016;48:128–31.

    Article  CAS  PubMed  Google Scholar 

  26. Ruiz-Del-Arbol L, Achecar L, Serradilla R, Rodriguez-Gandia MA, Rivero M, Garrido E, Natcher JJ. Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension and a normal creatinine. Hepatology. 2013;58:1732–41.

    Article  CAS  PubMed  Google Scholar 

  27. Sampaio F, Pimenta J. Left ventricular function assessment in cirrhosis: current methods and future directions. World J Gastroenterol. 2016;22:112–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Oh JK, Kane GC. Diastolic stress echocardiography: the time has come for its integration into clinical practice. J Am Soc Echocardiogr. 2014;27:1060–3.

    Article  PubMed  Google Scholar 

  29. Dahl EK, Møller S, Kjær A, Petersen CL, Bendtsen F, Krag A. Diastolic and autonomic dysfunction in early cirrhosis: a dobutamine stress study. Scand J Gastroenterol. 2014;49:362–72.

    Article  PubMed  Google Scholar 

  30. Krag A, Bendtsen F, Dahl EK, Kjær A, Petersen CL, Møller S. Cardiac function in patients with early cirrhosis during maximal beta-adrenergic drive: a dobutamine stress study. PLoS One. 2014;9:e109179.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Barbosa M, Guardado J, Marinho C, Rosa B, Quelhas I, Lourenço A, et al. Cirrhotic cardiomyopathy: isn’t stress evaluation always required for the diagnosis? World J Hepatol. 2016;8:200–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Umphrey LG, Hurst RT, Eleid MF, Lee KS, Reuss CS, Hentz JG, et al. Preoperative dobutamine stress echocardiographic findings and subsequent short-term adverse cardiac events after orthotopic liver transplantation. Liver Transpl. 2008;14:886–92.

    Article  PubMed  Google Scholar 

  33. Wiese S, Hove JD, Møller S. Cardiac imaging in patients with chronic liver disease. Clin Physiol Funct Imaging. 2017;37:347–56.

    Article  PubMed  Google Scholar 

  34. Mozos I. Arrhythmia risk in liver cirrhosis. World J Hepatol. 2015;7:662–72.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pall A, Czifra A, Vitális Z, Papp M, Paragh G, Szabó Z. Pathophysiological and clinical approach to cirrhotic cardiomyopathy. J Gastrointestin Liver Dis. 2014;23:301–10.

    PubMed  Google Scholar 

  36. Kimer N, Goetze JP, Bendtsen F, Moller S. New vasoactive peptides in cirrhosis: organ extraction and relation to the vasodilatory state. Eur J Clin Investig. 2014;44:441–52.

    Article  CAS  Google Scholar 

  37. Chayanupatkul M, Liangpunsakul S. Cirrhotic cardiomyopathy: review of pathophysiology and treatment. Hepatol Int. 2014;8:308–15.

    Article  PubMed  Google Scholar 

  38. Ruiz-del-Árbol L, Serradilla R. Cirrhotic cardiomyopathy and circulatory function. World J Gastroenterol. 2015;21:11502–21.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Silvestre OM, Farias AQ, Ramos DS, Furtado MS, Rodrigues AC, Ximenes RO, et al. β-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial. Eur J Gastroenterol Hepatol. 2018;30:930–7.

    Article  CAS  PubMed  Google Scholar 

  40. Sonny A, Ibrahim A, Schuster A, Jaber WA, Cywinski JB. Impact and persistence of cirrhotic cardiomyopathy after liver transplantation. Clin Transpl. 2016;30:986–93.

    Article  Google Scholar 

Further Reading

  • Acosta F, De La Morena G, Villegas M, Sansano T, Reche M, Beltran R, Roques V, et al. Evaluation of cardiac function before and after liver transplantation. Transplant Proc. 1999;31:2369–70.

    Article  CAS  PubMed  Google Scholar 

  • Alexopoulou A, Papatheodoridis G, Pouriki S, Chrysohoou C, Raftopoulos L, Stefanadis C, Pectasides D. Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis. Transpl Int. 2012;25:1174–81.

    Article  PubMed  Google Scholar 

  • Baik SK, Fouad TR, Lee SS. Cirrhotic cardiomyopathy. Orphanet J Rare Dis. 2007;2:15–27.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bolognesi M, Sacerdoti D, Piva A, Di Pascoli M, Zampieri F, Quarta S, Baik SK, Fouad TR, Lee SS. Carbon monoxide-mediated activation of large conductance calcium-activated potassium channels contributes to mesenteric vasodilatation in cirrhotic rats. J Pharmacol Exp Ther. 2007;321:187–94.

    Article  CAS  PubMed  Google Scholar 

  • Bernardi M, Rubboli A, Trevisani F, Cancellieri C, Ligabue A, Baraldini M, et al. Reduced cardiovascular responsiveness to exercise-induced sympatho-adrenergic stimulation in patients with cirrhosis. J Hepatol. 1991;12:207–16.

    Article  CAS  PubMed  Google Scholar 

  • Bernardi M, Calandra S, Colantoni A, Trevisani F, Raimondo ML, Sica G, Schepis F, Mandini M, Simoni P, Contin M, et al. Q-T interval prolongation in cirrhosis: prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors. Hepatology. 1998;27:28–34.

    Article  CAS  PubMed  Google Scholar 

  • Bonz A, Laser M, Kullmer S, Kniesch S, Babin-Ebell J, Popp V, Ertl G, Wagner JA. Cannabinoids acting on CB1 receptors decrease contractile performance in human atrial muscle. J Cardiovasc Pharmacol. 2003;41:657–64.

    Article  CAS  PubMed  Google Scholar 

  • Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C, Bernazzali S, Maccherini M. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound. 2010;8:14.

    Article  PubMed  PubMed Central  Google Scholar 

  • Campbell DJ, Mitchelhill KI, Schlicht SM, Booth RJ. Plasma amino-terminal pro-brain natriuretic peptide: a novel approach to the diagnosis of cardiac dysfunction. J Card Fail. 2000;6:130–9.

    Article  CAS  PubMed  Google Scholar 

  • Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, Meregaglia D, Nicolini A. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut. 2007;56:869–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dowsley TF, Bayne DB, Langnas AN, Dumitru I, Windle JR, Porter TR, Raichlin E. Diastolic dysfunction in patients with end-stage liver disease is associated with development of heart failure early after liver transplantation. Transplantation. 2012;94(6):646–51.

    Article  PubMed  Google Scholar 

  • Fouad TR, Abdel-Razek WM, Burak KW, Bain VG, Lee SS. Prediction of cardiac complications after liver transplantation. Transplantation. 2009;87:763–70.

    Article  PubMed  Google Scholar 

  • Garcia-Estan J, Ortiz MC, Lee SS. Nitric oxide and renal and cardiac dysfunction in cirrhosis. Clin Sci. 2002;102:213–22.

    Article  CAS  Google Scholar 

  • Henriksen JH, Fuglsang S, Bendtsen F, Christensen E, Møller S. Dyssynchronous electrical and mechanical systole in patients with cirrhosis. J Hepatol. 2002;36:513–20.

    Article  PubMed  Google Scholar 

  • Henriksen JH, Gotze JP, Fuglsang S, Christensen E, Bendtsen F, Moller S. Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut. 2003;52:1511–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hoyert D, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61:1–51.

    PubMed  Google Scholar 

  • Kazankov K, Holland-Fischer P, Andersen NH, Torp P, Sloth E, Aagaard NK, Vilstrup H. Resting myocardial dysfunction in cirrhosis quantified by tissue Doppler imaging. Liver Int. 2011;31:534–40.

    Article  PubMed  Google Scholar 

  • Kowalski HJ, Abelmann WH. The cardiac output at rest in Laennec’s cirrhosis. J Clin Invest. 1953;32:1025–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Krag A, Bendtsen F, Mortensen C, Henriksen JH, Møller S. Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis. Eur J Gastroenterol Hepatol. 2010;22:1085–92.

    Article  CAS  PubMed  Google Scholar 

  • Lee SS, Liu H. Cardiovascular determinants of survival in cirrhosis. Gut. 2007;56:746–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Liu H, Gaskari SA, Lee SS. Cardiac and vascular changes in cirrhosis: pathogenic mechanisms. World J Gastroenterol. 2006;12:837–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lossnitzer D, Steen H, Zahn A, Lehrke S, Weiss C, Weiss KH, et al. Myocardial late gadolinium enhancement cardiovascular magnetic resonance in patients with cirrhosis. J Cardiovasc Magn Reson. 2010;12:47.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ma Z, Miyamoto A, Lee SS. Role of altered beta-adrenoceptor signal transduction in the pathogenesis of cirrhotic cardiomyopathy in rats. Gastroenterology. 1996;110:1191–8.

    Article  CAS  PubMed  Google Scholar 

  • Madhwal S, Atreja A, Albeldawi M, Lopez R, Post A, Costa MA. Is liver transplantation a risk factor for cardiovascular disease? A meta-analysis of observational studies. Liver Transpl. 2012;18:1140–6.

    Article  PubMed  Google Scholar 

  • McCaughan GW. Trekking new ground: overcoming medical and social impediments for extended criteria liver transplant recipients. Liver Transpl. 2012;18(Suppl 2):S39–46.

    Article  PubMed  Google Scholar 

  • Møller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53:179–90.

    Article  PubMed  Google Scholar 

  • Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr. 2011;12:167–205.

    Article  PubMed  Google Scholar 

  • Murray JF, Dawson AM, Sherlock S. Circulatory changes in chronic liver disease. Am J Med. 1958;24:358–67.

    Article  CAS  PubMed  Google Scholar 

  • Pozzi M, Grassi G, Ratti L, Favini G, Dell’Oro R, Redaelli E, et al. Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral child A cirrhosis. Am J Gastroenterol. 2005;100:1110–6.

    Article  CAS  PubMed  Google Scholar 

  • Rudzinski W, Waller AH, Prasad A, Sood S, Gerula C, Samanta A, Koneru B, Klapholz M. New index for assessing the chronotropic response in patients with end-stage liver disease who are undergoing dobutamine stress echocardiography. Liver Transpl. 2012;18:355–60.

    Article  PubMed  Google Scholar 

  • Ripoll C, Yotti R, Bermejo J, Bañares R. The heart in liver transplantation. J Hepatol. 2011;54:810–22.

    Article  PubMed  Google Scholar 

  • Ruiz-del-Arbol L, Monescillo A, Arocena C, Valer P, Gines P, Moreira V, et al. Circulatory function and hepatorenal syndrome in cirrhosis. Hepatology. 2005;42:439–47.

    Article  CAS  PubMed  Google Scholar 

  • Sersté T, Francoz C, Durand F, Rautou PE, Melot C, Valla D, Moreau R, Lebrec D. Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites: a cross-over study. J Hepatol. 2011;55:794–9.

    Article  PubMed  CAS  Google Scholar 

  • Therapondos G, Flapan AD, Dollinger MM, Garden OJ, Plevris JN, Hayes PC. Cardiac function after orthotopic liver transplantation and the effects of immunosuppression: a prospective randomized trial comparing cyclosporin (Neoral) and tacrolimus. Liver Transpl. 2002;8:690–700.

    Article  PubMed  Google Scholar 

  • Torregrosa M, Aguadé S, Dos L, Segura R, Gónzalez A, Evangelista A, et al. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol. 2005;42:68–74.

    Article  PubMed  Google Scholar 

  • Trevisani F, Di Micoli A, Zambruni A, Biselli M, Santi V, Erroi V, et al. QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis. Liver Int. 2012;32:1510–5.

    Article  CAS  PubMed  Google Scholar 

  • Williams K, Lewis JF, Davis G, Geiser EA. Dobutamine stress echocardiography in patients undergoing liver transplantation evaluation. Transplantation. 2000;69:2354–6.

    Article  CAS  PubMed  Google Scholar 

  • Wong F, Girgrah N, Graba J, Allidina Y, Liu P, Blendis L. The cardiac response to exercise in cirrhosis. Gut. 2001;49:268–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wong F, Siu S, Liu P, Blendis LM. Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis? Clin Sci. 2001;101:621–8.

    Article  CAS  Google Scholar 

  • Wong F. Cirrhotic cardiomyopathy. Hepatol Int. 2009;3:294–304.

    Article  PubMed  Google Scholar 

  • Yang YY, Lin HC. The heart: pathophysiology and clinical implications of cirrhotic cardiomyopathy. J Chin Med Assoc. 2012;75:619–23.

    Article  CAS  PubMed  Google Scholar 

  • Zardi EM, Abbate A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW, et al. Cirrhotic Cardiomyopathy. J Am Coll Cardiol. 2010;56:539–49.

    Article  CAS  PubMed  Google Scholar 

  • Ziada D, Gaber R, Kotb N, Ghazy M, Nagy H. Predictive value of N-terminal pro B-type natriuretic peptide in tissue Doppler-diagnosed cirrhotic cardiomyopathy. Heart Mirror J. 2011;5:264–70.

    Google Scholar 

  • Zambruni A, Trevisani F, Di Micoli A, Savelli F, Berzigotti A, Bracci E. Effect of chronic beta-blockade on QT interval in patients with liver cirrhosis. J Hepatol. 2008;48:415–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

    Roxana Cristina Rimbas, Alexandra Maria Chitroceanu & Dragos Vinereanu

  2. Cardiology Department, University and Emergency Hospital, Bucharest, Romania

    Roxana Cristina Rimbas & Dragos Vinereanu

Authors
  1. Roxana Cristina Rimbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra Maria Chitroceanu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dragos Vinereanu
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Cirrhotic cardiomyopathy is an entity described in patients with liver cirrhosis. It consists of:

    1. (a)

      Prolonged QT interval

    2. (b)

      Subtle diastolic and systolic dysfunction

    3. (c)

      Inotropic and chronotropic incompetence

    4. (d)

      All the above

  2. 2.

    The commonest electrophysiological abnormalities found in cirrhotic cardiomyopathy is:

    1. (a)

      Atrial fibrillation

    2. (b)

      Prolonged QT interval

    3. (c)

      Frequent atrial and ventricular ectopic beats

    4. (d)

      Torsades des point

  3. 3.

    Cardiac dysfunction from cirrhotic cardiomyopathy is related to several pathophysiological changes. Which one of the following is correct?

    1. (a)

      Various gases such as nitric oxide and carbon monoxide causing direct suppressive action on the cardiomyocytes

    2. (b)

      Inflammatory cytokines stimulated form intestinal endotoxemia in liver cirrhosis exerting a pro-fibrotic and pro-inflammatory action on the cardiomyocytes

    3. (c)

      There is altered cardiomyocyte plasma membrane fluidity

    4. (d)

      All the above

1.2 Answers

  1. 1.

    Cirrhotic cardiomyopathy is an entity described in patients with liver cirrhosis. It consists of:

    • Answer: (d).

  2. 2.

    The commonest electrophysiological abnormalities found in cirrhotic cardiomyopathy is:

    • Answer: (b).

  3. 3.

    Cardiac dysfunction from cirrhotic cardiomyopathy is related to several pathophysiological changes. Which one of the following is correct?

    • Answer: (d).

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rimbas, R.C., Chitroceanu, A.M., Vinereanu, D. (2020). Cirrhotic Cardiomyopathy. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24432-3_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24431-6

  • Online ISBN: 978-3-030-24432-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation