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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2016; 22(1): 112-125
Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.112
Left ventricular function assessment in cirrhosis: Current methods and future directions
Francisco Sampaio, Joana Pimenta
Francisco Sampaio, Cardiology Department, Centro Hospitalar de Gaia/Espinho, 4430-502 Vila Nova de Gaia, Portugal
Francisco Sampaio, Joana Pimenta, Cardiovascular Research & Development Unit, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
Author contributions: Sampaio F reviewed the literature and drafted the paper; Pimenta J reviewed the paper critically for important intellectual content; both authors read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
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:
Correspondence to: Francisco Sampaio, MD, PhD, Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Portugal.
Telephone: +351-227-865100 Fax: +351-227-830209
Received: April 27, 2015
Peer-review started: April 29, 2015
First decision: July 14, 2015
Revised: July 29, 2015
Accepted: October 13, 2015
Article in press: October 13, 2015
Published online: January 7, 2016

Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.

Keywords: Cirrhosis, Cardiomyopathy, Echocardiography, Magnetic resonance imaging, Systolic function, Diastolic function, Deformation imaging

Core tip: Cardiac dysfunction has been documented in cirrhosis. Conventional non-invasive methods are frequently used to detect abnormalities. Newer imaging techniques have been developed and can contribute to a more accurate diagnosis of cirrhotic cardiomyopathy. However, it is essential to understand the strengths and limitations of every modality in order to correctly interpret the results. Currently applied methods for assessing left ventricular myocardial function as well as future perspectives are reviewed.