title: Cardiac dysfunction in cirrhosis - does adrenal function play a role? A hypothesis.
abstract: Cirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with advanced disease. Down-regulation and decreased number of beta-adrenergic receptors, and high catecholamine levels are common to both cardiac conditions. Thus, AI may play a role in CCM. Steroid replacement therapy reverses cardiac changes in AI, and may do so for CCM, with important therapeutic implications; this needs formal evaluation.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Royal Free Hampstead NHS Trust and UCL, London, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Theocharidou
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000311:Adrenal Glands / Q000378:metabolism*; D000309:Adrenal Insufficiency / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D002395:Catecholamines / Q000378:metabolism; D015536:Down-Regulation; D005938:Glucocorticoids / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D008133:Long QT Syndrome / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008901:Mineralocorticoids / Q000378:metabolism; D011943:Receptors, Adrenergic, beta / Q000378:metabolism; D018754:Ventricular Dysfunction / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D002395:Catecholamines; D005938:Glucocorticoids; D008901:Mineralocorticoids; D011943:Receptors, Adrenergic, beta