TY - JOUR
T1 - Recent advances in the diagnosis and management of cirrhosis-associated cardiomyopathy in liver transplant candidates
T2 - Advanced echo imaging, cardiac biomarkers, and advanced heart failure therapies
AU - Farr, Maryjane
AU - Schulze, Paul Christian
N1 - Publisher Copyright:
© the authors, publisher and licensee Libertas Academica Limited.
PY - 2015/1/28
Y1 - 2015/1/28
N2 - Patients with end-stage liver disease in need of liver transplantation increasingly are older with a greater burden of cardiac disease and other co-morbidities, which may increase perioperative risk and adversely affect long-term prognosis. Cirrhosis of any etiology manifests hemodynamically as a state of low systemic vascular resistance, with high peripheral, but low central blood volume, leading to a state of neurohormonal activation and high cardiac output, which may adversely affect cardiac reserve under extreme perioperative stress, aptly termed cirrhosis-associated or cirrhotic cardiomyopathy. Evi-dence of asymptomatic cirrhotic cardiomyopathy may be found in subtle electrocardiographic and echocardiographic changes, but may progress to severe heart failure under the demands of bleeding and transfusions, vasopressors, rebounding peripheral vascular resistance, withdrawal of cardioprotective beta-blockers and mineralocorticoid antagonists, exacerbated by sepsis or systemic inflammatory response syndrome. This review will add to the current body of literature on cirrhotic cardiomyopathy by focusing on the role of advanced echocardiographic imaging techniques, cardiac biomarkers, and advanced heart failure therapies available to manage patients with cirrhotic cardiomyopathy while waiting for liver transplant and during the perioperative period.
AB - Patients with end-stage liver disease in need of liver transplantation increasingly are older with a greater burden of cardiac disease and other co-morbidities, which may increase perioperative risk and adversely affect long-term prognosis. Cirrhosis of any etiology manifests hemodynamically as a state of low systemic vascular resistance, with high peripheral, but low central blood volume, leading to a state of neurohormonal activation and high cardiac output, which may adversely affect cardiac reserve under extreme perioperative stress, aptly termed cirrhosis-associated or cirrhotic cardiomyopathy. Evi-dence of asymptomatic cirrhotic cardiomyopathy may be found in subtle electrocardiographic and echocardiographic changes, but may progress to severe heart failure under the demands of bleeding and transfusions, vasopressors, rebounding peripheral vascular resistance, withdrawal of cardioprotective beta-blockers and mineralocorticoid antagonists, exacerbated by sepsis or systemic inflammatory response syndrome. This review will add to the current body of literature on cirrhotic cardiomyopathy by focusing on the role of advanced echocardiographic imaging techniques, cardiac biomarkers, and advanced heart failure therapies available to manage patients with cirrhotic cardiomyopathy while waiting for liver transplant and during the perioperative period.
KW - Cirrhosis
KW - Cirrhotic cardiomyopathy
KW - Galectin-3
KW - Heart failure
KW - Liver transplantation
KW - Mechanical circulatory support devices
KW - Strain imaging
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UR - http://www.scopus.com/inward/citedby.url?scp=84962868888&partnerID=8YFLogxK
U2 - 10.4137/CMC.S15722
DO - 10.4137/CMC.S15722
M3 - Review article
C2 - 25657603
AN - SCOPUS:84962868888
SN - 1179-5468
VL - 8
SP - 67
EP - 74
JO - Clinical Medicine Insights: Cardiology
JF - Clinical Medicine Insights: Cardiology
ER -