Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics
Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic an...
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2024-12-01
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| author | Ivan Rankovic Ivana Babic Jelena Martinov Nestorov Jelena Bogdanovic Maja Stojanovic Jovanka Trifunovic Nikola Panic Mihailo Bezmarevic Jelena Jevtovic Dusan Micic Vladimir Dedovic Nemanja Djuricic Filip Pilipovic Elena Curakova Ristovska Tijana Glisic Sanja Kostic Nemanja Stojkovic Nata Joksimovic Mileva Bascarevic Aleksandra Bozovic Lewis Elvin Ajibola Onifade Keith Siau Elizaveta Koriakovskaia Vladimir Milivojevic |
| author_facet | Ivan Rankovic Ivana Babic Jelena Martinov Nestorov Jelena Bogdanovic Maja Stojanovic Jovanka Trifunovic Nikola Panic Mihailo Bezmarevic Jelena Jevtovic Dusan Micic Vladimir Dedovic Nemanja Djuricic Filip Pilipovic Elena Curakova Ristovska Tijana Glisic Sanja Kostic Nemanja Stojkovic Nata Joksimovic Mileva Bascarevic Aleksandra Bozovic Lewis Elvin Ajibola Onifade Keith Siau Elizaveta Koriakovskaia Vladimir Milivojevic |
| author_sort | Ivan Rankovic |
| collection | DOAJ |
| description | Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae. |
| format | Article |
| id | doaj-art-9468aa97aba148dab32a02ddbf605b04 |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-12-01 |
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| series | Medicina |
| spelling | doaj-art-9468aa97aba148dab32a02ddbf605b042025-01-24T13:40:22ZengMDPI AGMedicina1010-660X1648-91442024-12-016114610.3390/medicina61010046Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied TacticsIvan Rankovic0Ivana Babic1Jelena Martinov Nestorov2Jelena Bogdanovic3Maja Stojanovic4Jovanka Trifunovic5Nikola Panic6Mihailo Bezmarevic7Jelena Jevtovic8Dusan Micic9Vladimir Dedovic10Nemanja Djuricic11Filip Pilipovic12Elena Curakova Ristovska13Tijana Glisic14Sanja Kostic15Nemanja Stojkovic16Nata Joksimovic17Mileva Bascarevic18Aleksandra Bozovic19Lewis Elvin20Ajibola Onifade21Keith Siau22Elizaveta Koriakovskaia23Vladimir Milivojevic24Gastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, London TR1 3LJ, UKClinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaClinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaClinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaFaculty of Medicine, University of Belgrade, 11 000 Belgrade, SerbiaFaculty of Dentistry Pancevo, University of Business Academy in Novi Sad, 21 000 Novi Sad, SerbiaFaculty of Medicine, University of Belgrade, 11 000 Belgrade, SerbiaClinic for General Surgery, Military Medical Academy, Military Medical Academy Medical Faculty, University of Defense, 11 000 Belgrade, SerbiaClinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaFaculty of Medicine, University of Belgrade, 11 000 Belgrade, SerbiaFaculty of Medicine, University of Belgrade, 11 000 Belgrade, SerbiaClinic for Cardiology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaInstitute for Orthopedic Surgery “Banjica”, 11 000 Belgrade, SerbiaUniversity Clinic for Gastroenterohepatology, 1000 Skopje, North MacedoniaClinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaClinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaDepartment of Cardiology, University Clinic “Dr Dragisa Misovic”, 11 000 Belgrade, SerbiaClinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaClinic for Allergy and Immunology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaClinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaGastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, London TR1 3LJ, UKGastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, London TR1 3LJ, UKGastroenterology and Liver Unit, Royal Cornwall Hospitals NHS Trust, London TR1 3LJ, UKDepartment of Cardiology, Moscow State University of Medicine and Dentistry, 127473 Moscow, RussiaClinic for Gastroenterology and Hepatology, University Clinical Centre of Serbia, 11 000 Belgrade, SerbiaCirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae.https://www.mdpi.com/1648-9144/61/1/46cirrhotic cardiomyopathycirrhosispathogenesistreatment |
| spellingShingle | Ivan Rankovic Ivana Babic Jelena Martinov Nestorov Jelena Bogdanovic Maja Stojanovic Jovanka Trifunovic Nikola Panic Mihailo Bezmarevic Jelena Jevtovic Dusan Micic Vladimir Dedovic Nemanja Djuricic Filip Pilipovic Elena Curakova Ristovska Tijana Glisic Sanja Kostic Nemanja Stojkovic Nata Joksimovic Mileva Bascarevic Aleksandra Bozovic Lewis Elvin Ajibola Onifade Keith Siau Elizaveta Koriakovskaia Vladimir Milivojevic Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics Medicina cirrhotic cardiomyopathy cirrhosis pathogenesis treatment |
| title | Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics |
| title_full | Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics |
| title_fullStr | Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics |
| title_full_unstemmed | Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics |
| title_short | Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics |
| title_sort | joint group and multi institutional position opinion cirrhotic cardiomyopathy from fundamentals to applied tactics |
| topic | cirrhotic cardiomyopathy cirrhosis pathogenesis treatment |
| url | https://www.mdpi.com/1648-9144/61/1/46 |
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