Cirrhotic cardiomyopathy – negative prognosis factor in cirrhosis

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.