Abstract
Cirrhotic cardiomyopathy is a complication of cirrhosis which is still incompletely elucidated, being underdiagnosed due to the fact that it is generally latent at rest and it only manifests under stress; however, it can have a bad impact on the prognosis of cirrhotic patients. It is characterized by an impaired hemodynamic response to stress, a hyperdinamic circulatory status, systolic and diastolic dysfunction and electrophysiological impairments (most frequently, QT prolongation). The diagnosis is difficult because cirrhotic cardiomyopathy is usually asymptomatic at rest and the hemodynamic alterations together with the signs and symptoms of heart failure appear only in stressful conditions (effort, drugs, infections, hemorrhage, surgery etc.). The diagnosis is made by identifying systolic and diastolic dysfunction through stress echocardiography (effort, dobutamine etc.) or using myocardial strain imaging. In the absence of a proper diagnosis and treatment, cirrhotic cardiomyopathy can lead to severe complications such as heart failure, arrhythmias, hepatorenal syndrome or sudden death. At the moment, there is no standardized protocol for the treatment of cirrhotic cardiomyopathy, but the main therapeutic options are loop diuretics, aldosterone receptor antagonists, nonselective beta-blockers (in particular carvedilol) or angiotensin-converting enzyme inhibitors. Liver transplant significantly improves systolic and diastolic dysfunction and can reverse QT prolongation in some patients. However, there are limited studies that show a risk for cardiovascular complications after liver transplant. Therefore, a complex cardiovascular evaluation is recommended before and after the transplant.
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