摘要
Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response t o s t r e s s, i m p a i r e d d i a s t o l i c r e l a x a t i o n o f t h e myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of theβ-adrenergic receptor. Diagnosis can be made using a combination of echocardiography(resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy.
Cirrhotic cardiomyopathy is a disease that has onlyrecently been recognised as a definitive clinical entity.In the setting of liver cirrhosis, it is characterizedby a blunted inotropic and chronotropic responseto stress, impaired diastolic relaxation of themyocardium and prolongation of the QT interval inthe absence of other known cardiac disease. A keypathological feature is the persistent over-activationof the sympathetic nervous system in cirrhosis, whichleads to down-regulation and dysfunction of theβ-adrenergic receptor. Diagnosis can be made using acombination of echocardiography （resting and stress）,tissue Doppler imaging, cardiac magnetic resonanceimaging, 12-lead electrocardiogram and measurementof biomarkers. There are significant implications of cirrhoticcardiomyopathy in a number of clinical situations in whichthere is an increased physiological demand, whichcan lead to acute cardiac decompensation and heartfailure. Prior to transplantation there is an increasedrisk of hepatorenal syndrome, cardiac failure followingtransjugular intrahepatic portosystemic shunt insertionand increased risk of arrhythmias during acutegastrointestinal bleeding. Liver transplantation presentsthe greatest physiological challenge with a furtherrisk of acute cardiac decompensation. Peri-operativemanagement should involve appropriate choice of graftand minimization of large fluctuations in preload andafterload. The avoidance of cardiac failure during thisperiod has important prognostic implications, as thereis evidence to suggest a long-term resolution of theabnormalities in cirrhotic cardiomyopathy.
