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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11502-11521
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11502
Cirrhotic cardiomyopathy
Luis Ruiz-del-Árbol, Regina Serradilla
Luis Ruiz-del-Árbol, Regina Serradilla, Hepatic Hemodynamic Unit, Gastroenterology Department, Hospital Ramón y Cajal, University of Alcalá, 28034 Madrid, Spain
Author contributions: Ruiz-del-Árbol L designed, performed research, analyzed data and wrote the paper; Serradilla R performed research and analyzed data.
Supported by Grants from Fondo de Investigaciones Sanitarias (FIS 06/1082, in part).
Conflict-of-interest statement: The authors had no conflicts of interest to declare in relation to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luis Ruiz-del-Árbol, MD, Hepatic Hemodynamic Unit, Gastroenterology Department, Hospital Ramón y Cajal, University of Alcalá, Ctra. de Colmenar Viejo Km 9.1, 28034 Madrid, Spain. lruizarbol@gmail.com
Telephone: +34-913-368387 Fax: +34-913-368085
Received: April 15, 2015
Peer-review started: April 17, 2015
First decision: May 18, 2015
Revised: June 17, 2015
Accepted: September 14, 2015
Article in press: September 14, 2015
Published online: November 7, 2015
Processing time: 201 Days and 23.2 Hours
Abstract

During the course of cirrhosis, there is a progressive deterioration of cardiac function manifested by the disappearance of the hyperdynamic circulation due to a failure in heart function with decreased cardiac output. This is due to a deterioration in inotropic and chronotropic function which takes place in parallel with a diastolic dysfunction and cardiac hypertrophy in the absence of other known cardiac disease. Other findings of this specific cardiomyopathy include impaired contractile responsiveness to stress stimuli and electrophysiological abnormalities with prolonged QT interval. The pathogenic mechanisms of cirrhotic cardiomyopathy include impairment of the b-adrenergic receptor signalling, abnormal cardiomyocyte membrane lipid composition and biophysical properties, ion channel defects and overactivity of humoral cardiodepressant factors. Cirrhotic cardiomyopathy may be difficult to determine due to the lack of a specific diagnosis test. However, an echocardiogram allows the detection of the diastolic dysfunction and the E/e′ ratio may be used in the follow-up progression of the illness. Cirrhotic cardiomyopathy plays an important role in the pathogenesis of the impairment of effective arterial blood volume and correlates with the degree of liver failure. A clinical consequence of cardiac dysfunction is an inadequate cardiac response in the setting of vascular stress that may result in renal hypoperfusion leading to renal failure. The prognosis is difficult to establish but the severity of diastolic dysfunction may be a marker of mortality risk. Treatment is non-specific and liver transplantation may normalize the cardiac function.

Keywords: Cirrhotic cardiomyopathy; Inotropic heart dysfunction; Left ventricular diastolic dysfunction; E/e’ ratio; Arterial blood volume; Cirrhosis; Liver failure; Hepatorenal syndrome

Core tip: During the course of cirrhosis, there is an impairment in cardiac function with decrease in cardiac output. This process is due to a cirrhotic cardiomyopathy with diastolic dysfunction that may compromise the inotropic function which takes place in parallel with a chronotropic heart dysfunction. This cardiomyopathy plays an important role in the pathogenesis of the impairment of effective arterial blood volume in cirrhosis. The clinical consequences of cardiac dysfunction may be an inadequate cardiac output in response to clinical events that produce effective hypovolemia leading to renal failure. The severity of cardiomyopathy is a marker of advanced cirrhosis and mortality.