Hepato-cardiac disorders

Table 1 Proposal for diagnostic and supportive criteria for cirrhotic cardiomyopathy agreed upon at a working party held at the 2005 World Congress of Gastroenterology

A working definition of cirrhotic cardiomyopathy

A cardiac dysfunction in patients with cirrhosis characterised by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease

Diagnostic criteria

Systolic dysfunction

Blunted increase in cardiac output with exercise, volume challenge or pharmacological stimuli

Resting EF < 55%

Diastolic dysfunction

E/A ratio < 1.0 (age-corrected)

Prolonged deceleration time (> 200 ms)

Prolonged isovolumetric relaxation time (> 80 ms)

Supportive criteria

Electrophysiological abnormalities

Abnormal chronotropic response

Electromechanical uncoupling/dyssynchrony

Prolonged QTc interval

Enlarged left atrium

Increased myocardial mass

Increased BNP and pro-BNP

Increased troponin I

BNP: Brain natriuretic peptide; E/A: Early diastolic/atrial filling ratio; EF: Left-ventricular ejection fraction.