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.
KeywordsCirrhotic cardiomyopathy Diastolic dysfunction Systolic dysfunction Electrophysiological abnormalities Biomarkers
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