From the Department of Anaesthesia and Intensive Care Medicine III, Fundeni Clinical Institute, Bucharest, Romania.
Department of Cardiac Surgery, Pavlov First St Petersburg Medical University, St Petersburg, Russian Federation.
Cardiol Rev. 2022;30(2):80-89. doi: 10.1097/CRD.0000000000000377.
Cirrhotic cardiomyopathy (CCM) is defined as cardiac dysfunction in patients with liver cirrhosis without preexisting cardiac disease. According to the definition established by the World Congress of Gasteroenterology in 2005, the diagnosis of CCM includes criteria reflecting systolic dysfunction, impaired diastolic relaxation, and electrophysiological disturbances. Because of minimal or even absent clinical symptoms and echocardiographic signs at rest according to the 2005 criteria, CCM diagnosis is often missed or delayed in most clinically stable cirrhotic patients. However, cardiac dysfunction progresses in time and contributes to the pathogenesis of hepatorenal syndrome and increased morbidity and mortality after liver transplantation, surgery, or other invasive procedures in cirrhotic patients. Therefore, a comprehensive cardiovascular assessment using newer techniques for echocardiographic evaluation of systolic and diastolic function, allowing the diagnosis of CCM in the early stage of subclinical cardiovascular dysfunction, should be included in the screening process of liver transplant candidates and patients with cirrhosis in general. The present review aims to summarize the most important pathophysiological aspects of CCM, the usefulness of contemporary cardiovascular imaging techniques and parameters in the diagnosis of CCM, the current therapeutic options, and the importance of early diagnosis of cardiovascular impairment in cirrhotic patients.
肝硬化性心肌病（CCM）定义为无先前心脏疾病的肝硬化患者的心脏功能障碍。根据 2005 年世界胃肠病学大会确立的定义，CCM 的诊断标准包括反映收缩功能障碍、舒张松弛受损和电生理紊乱的标准。由于根据 2005 年标准，大多数临床稳定的肝硬化患者在休息时的临床症状和超声心动图征象很少或甚至不存在，因此 CCM 的诊断经常被遗漏或延迟。然而，心脏功能障碍会随着时间的推移而进展，并导致肝肾综合征的发病机制以及增加肝硬化患者在肝移植、手术或其他侵入性操作后的发病率和死亡率。因此，应使用评估收缩和舒张功能的超声心动图新技术对肝移植候选者和一般肝硬化患者进行全面心血管评估，以在亚临床心血管功能障碍的早期诊断 CCM。本综述旨在总结 CCM 的最重要的病理生理方面、当代心血管成像技术和参数在 CCM 诊断中的应用、当前的治疗选择以及早期诊断肝硬化患者心血管损害的重要性。
