Cardiology Department, Carol Davila University of Medicine, Bucharest; Gastroenterology Department, University Emergency Hospital, Bucharest, Romania.
Cardiology Department, Carol Davila University of Medicine, Bucharest; Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
J Gastrointestin Liver Dis. 2020 Dec 13;29(4):665-675. doi: 10.15403/jgld-3137.
Liver cirrhosis (LC) is an important cause of mortality. Access to liver transplantation (LT) has significantly improved the prognosis of LC. A rigorous pre-transplant cardiac evaluation is mandatory, since cardiac dysfunction is considered the main cause of mortality after LT. Notwithstanding, the most updated pre-LT evaluation guidelines provide only an algorithm for the evaluation of major cardiovascular diseases, with no specific recommendations concerning cirrhotic cardiomyopathy (CCM), which is linked to various complications in LC, especially the development of heart failure after invasive procedures and surgical interventions, including LT. CCM is characterized by a cardiac dysfunction that includes systolic and/or diastolic dysfunction and/or electrophysiological abnormalities, in the absence of other known cardiac diseases. The role of the novel methods, tissue Doppler imaging and speckle tracking echocardiography, might be essential in the early detection of cardiac dysfunction, with prognosis implications in LC. All these new methods were only recently included in the CCM diagnosis algorithm. This review summarizes the old and novel techniques used for the diagnosis of CCM, with their diagnosis and prognostic role. It also highlights the strengths and the weaknesses of the new provided CCM diagnostic consensus, and proposes a step-by- step novel diagnostic algorithm, in order to better detect cardiac dysfunction.cirrhotic cardiomyopathy.
肝硬化（LC）是一种重要的死亡原因。接受肝移植（LT）显著改善了 LC 的预后。严格的移植前心脏评估是强制性的，因为心脏功能障碍被认为是 LT 后死亡的主要原因。尽管如此，最新的 LT 前评估指南仅提供了一种评估主要心血管疾病的算法，而对于与 LC 的各种并发症相关的肝硬化心肌病（CCM）没有具体的建议，特别是在侵入性程序和手术干预后发生心力衰竭，包括 LT。CCM 的特征是心脏功能障碍，包括收缩和/或舒张功能障碍和/或电生理异常，而没有其他已知的心脏病。新型方法，组织多普勒成像和斑点追踪超声心动图的作用可能对于早期检测心脏功能障碍至关重要，这对 LC 的预后有影响。所有这些新方法最近才被纳入 CCM 诊断算法。本综述总结了用于诊断 CCM 的旧的和新的技术，及其诊断和预后作用。它还强调了新的 CCM 诊断共识的优缺点，并提出了一个逐步的新的诊断算法，以更好地检测心脏功能障碍。
