Universität zu Köln

Gassanov, Natig, Caglayan, Evren, Semmo, Nasser, Massenkeil, Gero and Er, Fikret (2014). Cirrhotic cardiomyopathy: A cardiologist's perspective. World J. Gastroenterol., 20 (42). S. 15492 - 15499. PLEASANTON: BAISHIDENG PUBLISHING GROUP INC. ISSN 2219-2840

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Abstract

Cardiac dysfunction is frequently observed in patients with cirrhosis, and has long been linked to the direct toxic effect of alcohol. Cirrhotic cardiomyopathy (CCM) has recently been identified as an entity regardless of the cirrhosis etiology. Increased cardiac output due to hyperdynamic circulation is a pathophysiological hallmark of the disease. The underlying mechanisms involved in pathogenesis of CCM are complex and involve various neurohumoral and cellular pathways, including the impaired beta-receptor and calcium signaling, altered cardiomyocyte membrane physiology, elevated sympathetic nervous tone and increased activity of vasodilatory pathways predominantly through the actions of nitric oxide, carbon monoxide and endocannabinoids. The main clinical features of CCM include attenuated systolic contractility in response to physiologic or pharmacologic strain, diastolic dysfunction, electrical conductance abnormalities and chronotropic incompetence. Particularly the diastolic dysfunction with impaired ventricular relaxation and ventricular filling is a prominent feature of CCM. The underlying mechanism of diastolic dysfunction in cirrhosis is likely due to the increased myocardial wall stiffness caused by myocardial hypertrophy, fibrosis and subendothelial edema, subsequently resulting in high filling pressures of the left ventricle and atrium. Currently, no specific treatment exists for CCM. The liver transplantation is the only established effective therapy for patients with end-stage liver disease and associated cardiac failure. Liver transplantation has been shown to reverse systolic and diastolic dysfunction and the prolonged QT interval after transplantation. Here, we review the pathophysiological basis and clinical features of cirrhotic cardiomyopathy, and discuss currently available limited therapeutic options. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gassanov, Natig UNSPECIFIED UNSPECIFIED UNSPECIFIED Caglayan, Evren UNSPECIFIED UNSPECIFIED UNSPECIFIED Semmo, Nasser UNSPECIFIED UNSPECIFIED UNSPECIFIED Massenkeil, Gero UNSPECIFIED UNSPECIFIED UNSPECIFIED Er, Fikret UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-423337
DOI:	10.3748/wjg.v20.i42.15492
Journal or Publication Title:	World J. Gastroenterol.
Volume:	20
Number:	42
Page Range:	S. 15492 - 15499
Date:	2014
Publisher:	BAISHIDENG PUBLISHING GROUP INC
Place of Publication:	PLEASANTON
ISSN:	2219-2840
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LEFT-VENTRICULAR DYSFUNCTION; DUCT-LIGATED RATS; ORTHOTOPIC LIVER-TRANSPLANTATION; ALTERED LIPID-COMPOSITION; CONGESTIVE-HEART-FAILURE; NITRIC-OXIDE; CARDIAC ABNORMALITIES; PORTAL-HYPERTENSION; RECEPTORS MEDIATE; ASCITES Multiple languages Gastroenterology & Hepatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42333