Cirrhotic cardiomyopathy: pathogenesis, clinical features, diagnosis, treatment and prognosis

Abstract

Cardiac dysfunction among cirrhotic patients has been recognized for a long time in the medical community. While originally it was believed to be a result of direct alcohol toxicity, in the last thirty years, cirrhotic cardiomyopathy (CCM) has been described as a syndrome characterized by chronic cardiac dysfunction among cirrhotic patients in the absence of known cardiac disease, regardless of the etiology of cirrhosis. CCM occurs in about 60% of patients with cirrhosis and plays a critical role in disease progression and treatment outcomes. Due to its predominantly asymptomatic course, diagnosing CCM is challenging and requires a high index of suspicion and a multiparametric approach. Patients with CCM usually present with the following triad: impaired myocardial contractile response to exercise, inadequate ventricular relaxation and electrophysiological abnormalities (notably, prolonged QT interval). In recent years, research in this area has been growing expeditiously and a new set of diagnostic criteria has been developed by the Cirrhotic Cardiomyopathy Consortium, to properly identify patients with CCM. Nevertheless, CCM is still largely unknown among clinicians, and a major part of the pathophysiology and treatment is yet to be understood. In the present work, we aim to compile and summarize the available data on the pathogenesis, clinical features, diagnosis, treatment, and prognosis of CCM.