Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Hepatology. 2018 Nov;68(5):2008-2015. doi: 10.1002/hep.30040. Epub 2018 Oct 13.
Cirrhotic cardiomyopathy in end-stage liver disease is currently characterized by blunted contractile systolic response to stress with or without diastolic dysfunction in the absence of known heart disease. Since the establishment of the diagnostic criteria of cirrhotic cardiomyopathy in 2005, there have been multiple studies regarding its pathophysiology and pretransplant clinical course. The data regarding the post-transplant course of this entity are sparse. This review addresses the course and prognosis of the elements of cirrhotic cardiomyopathy after liver transplantation (LT). To this end, there is limited compelling evidence demonstrating the reversibility of this entity post-LT. Cirrhotic cardiomyopathy may, in fact, increase the risk of post-transplant complications. This review reveals a need to refine the diagnostic criteria of cirrhotic cardiomyopathy in view of the remarkable progress in the sphere of echocardiographic evaluation of systolic and diastolic dysfunction. The post-transplant course and outcomes related to cirrhotic cardiomyopathy may be better evaluated in the setting of updated diagnostic criteria.
终末期肝病的肝硬化性心肌病目前的特征是在没有已知心脏病的情况下，对压力的收缩性收缩反应迟钝，伴有或不伴有舒张功能障碍。自 2005 年确立肝硬化性心肌病的诊断标准以来，已有多项关于其病理生理学和移植前临床过程的研究。关于该实体移植后过程的数据很少。这篇综述讨论了肝移植 (LT) 后肝硬化性心肌病各要素的过程和预后。为此，只有有限的有力证据表明该实体在 LT 后具有可逆转性。肝硬化性心肌病实际上可能会增加移植后并发症的风险。鉴于超声心动图评估收缩和舒张功能障碍领域的显著进展，本综述表明需要对肝硬化性心肌病的诊断标准进行细化。根据更新的诊断标准，可以更好地评估与肝硬化性心肌病相关的移植后过程和结果。
