Abstract
Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications.
Highlights
The effects of end stage liver disease in the function of the cardiovascular system are a recognized clinical entity frequently referred to as cirrhotic cardiomyopathy (CCM) [1]
The detrimental effect of diastolic dysfunction in the prognosis of cirrhotic patients has been highlighted by studies displaying decreased survival in patients with increased left ventricular mass index (LVmassi) and left atrial volume index (LAVi) [38,44]. It is not clear whether LVmassi and LAVi behave as independent variables of survival or they are disturbed in advanced stages of liver disease as a result of the remodelling induced by the high output state
Cardiovascular dysfunction in cirrhotic patients without a preexisting cardiac disease is usually referred to as CCM, a condition characterized by high cardiac output and usually preserved systolic function at rest
Summary
The effects of end stage liver disease in the function of the cardiovascular system are a recognized clinical entity frequently referred to as cirrhotic cardiomyopathy (CCM) [1]. Cardiac manifestations in patients with advanced cirrhosis are a result of heart remodeling to compensate for the high output state and of the direct effects in the cardiac cell (Figure 1). Dysfunction of liver sinusoidal endothelial cells (LSEC) contribute to an increase in hepatic vascular resistance and portal hypertension [18]. They trigger signals which induce increased production of factors such as vascular endothelial growth factor and angiotensin-(1—7) [19,20]. Because of the increased frequency of metabolic syndrome and non-alcoholic fatty liver disease [35], frequency of NASH cirrhosis has increased leading to increased CAD prevalence in cirrhotic patients [36]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
