背景:肝硬化心肌病是指心脏的结构和功能变化导致收缩功能受损,舒张压,心电图,和与肝硬化和门脉高压相关的神经激素变化。肝硬化心肌病存在于50%的肝硬化患者中,临床上被视为收缩力受损,舒张功能障碍,高动力循环,和机电去同步,如QT延长。在这次审查中,我们将讨论肝硬化心肌病的心脏生理学原理,成像技术,如心脏磁共振成像和闪烁显像,心脏生物标志物,和较新的超声心动图技术,如组织多普勒成像和斑点追踪,和新兴的治疗方法,以改善结果。
方法:我们回顾了MEDLINE的随机对照试验文献,队列研究,横断面研究,和使用搜索词“肝硬化心肌病”的真实世界结果,左心室舒张功能不全,肝硬化心力衰竭,肝移植,“和”冠状动脉疾病“。
结果:肝硬化心肌病与肝肾综合征等并发症的风险增加有关,顽固性腹水,对包括脓毒症在内的应激源的反应受损,出血或移植,健康相关的生活质量差,发病率和死亡率增加。肝硬化心肌病的评估还应指导诸如经颈静脉肝内门体分流术的可行性,β受体阻滞剂的剂量滴定方案,和肝移植。使用靶向心率降低对改善心脏充盈和使用再利用的心力衰竭药物如伊伐布雷定改善心输出量是有意义的。肝移植也可以逆转肝硬化心肌病;然而,仔细的心脏评估对于排除冠状动脉疾病和改善围手术期心脏预后是必要的.
结论:需要更多关于新诊断标准的数据,分子和生化变化,和用于肝硬化心肌病的药物。在临床实践中应使用先进的成像技术。
BACKGROUND: Cirrhotic cardiomyopathy refers to the structural and functional changes in the heart leading to either impaired systolic, diastolic, electrocardiographic, and neurohormonal changes associated with cirrhosis and portal hypertension. Cirrhotic cardiomyopathy is present in 50% of patients with cirrhosis and is clinically seen as impaired contractility, diastolic dysfunction, hyperdynamic circulation, and electromechanical desynchrony such as QT prolongation. In this review, we will discuss the cardiac physiology principles underlying cirrhotic cardiomyopathy, imaging techniques such as cardiac magnetic resonance imaging and scintigraphy, cardiac biomarkers, and newer echocardiographic techniques such as tissue Doppler imaging and speckle tracking, and emerging treatments to improve outcomes.
METHODS: We reviewed available literature from MEDLINE for randomized controlled trials, cohort studies, cross-sectional studies, and real-world outcomes using the search terms \"cirrhotic cardiomyopathy,\" \"left ventricular diastolic dysfunction,\" \"heart failure in cirrhosis,\" \"liver transplantation,\" and \"coronary artery disease\".
RESULTS: Cirrhotic cardiomyopathy is associated with increased risk of complications such as hepatorenal syndrome, refractory ascites, impaired response to stressors including sepsis, bleeding or transplantation, poor health-related quality of life and increased morbidity and mortality. The evaluation of cirrhotic cardiomyopathy should also guide the feasibility of procedures such as transjugular intrahepatic portosystemic shunt, dose titration protocol of betablockers, and liver transplantation. The use of targeted heart rate reduction is of interest to improve cardiac filling and improve the cardiac output using repurposed heart failure drugs such as ivabradine. Liver transplantation may also reverse the cirrhotic cardiomyopathy; however, careful cardiac evaluation is necessary to rule out coronary artery disease and improve cardiac outcomes in the perioperative period.
CONCLUSIONS: More data are needed on the new diagnostic criteria, molecular and biochemical changes, and repurposed drugs in cirrhotic cardiomyopathy. The use of advanced imaging techniques should be incorporated in clinical practice.