title: Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase.
abstract: Patients with advanced liver cirrhosis may develop a clinical syndrome characterized by a blunted contractile responsiveness to stress and/or altered diastolic relaxation, called "cirrhotic cardiomyopathy." This syndrome, which is initially asymptomatic, is often misdiagnosed due to the presence of symptoms that characterize other disorders present in patients with advanced liver cirrhosis, such as exercise intolerance, fatigue, and dyspnea. Stress and other conditions such as liver transplantation and transjugular intrahepatic portosystemic shunt (TIPS) may unmask this syndrome. Liver transplantation in this group of patients results in a clinical improvement and can be a cure for the cardiomyopathy. However, post-transplant prognosis depends on the identification of cirrhotics with cardiomyopathy in the pre-transplant phase; an early diagnosis of cirrhotic cardiomyopathy in the pre-transplant phase may avoid an acute onset or worsening of cardiac failure after liver transplantation. Since a preserved left ventricular ejection fraction may mask the presence of cirrhotic cardiomyopathy, the use of newer noninvasive diagnostic techniques (i.e. tissue Doppler, myocardial strain) is necessary to identify cirrhotics with this syndrome, in the pre-transplant phase. A pre-transplant treatment of heart failure in cirrhotics with cardiomyopathy improves the quality of life in this phase and reduces the complications during and immediately after liver transplantation. Since specific therapies for cirrhotic cardiomyopathy are lacking, due to the absence of a clear understanding of the pathophysiology of the cardiomyopathy, further research in this field is required.
authors.affiliation: Department of Clinical Medicine, University Campus Bio-Medico, Rome, Italy. Electronic address: e.zardi@unicampus.it.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Zardi
authors.affiliation: Department of Cardiology, II School of Medicine, University La Sapienza, Ospedale Sant'Andrea, Rome, Italy.
authors.forename: Domenico Maria
authors.initials: DM
authors.lastname: Zardi
authors.affiliation: Department of Cardiology, II School of Medicine, University La Sapienza, Ospedale Sant'Andrea, Rome, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Chin
authors.affiliation: Virginia Commonwealth University-VCU Pauley Heart Center, Richmond, VA, USA.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sonnino
authors.affiliation: Department of Physiology and Pathology, University of Trieste, Trieste, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Dobrina
authors.affiliation: Virginia Commonwealth University-VCU Pauley Heart Center, Richmond, VA, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
mesh_terms: D058070:Asymptomatic Diseases / Q000628:therapy*; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D057234:Preoperative Period; D011379:Prognosis; D011788:Quality of Life; D013577:Syndrome
keywords: Cirrhotic cardiomyopathy; Echocardiography; Liver cirrhosis; Liver transplantation