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Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis
Author(s) -
Theocharidou Eleni,
Krag Aleksander,
Bendtsen Flemming,
Møller Søren,
Burroughs Andrew K.
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2011.02751.x
Subject(s) - medicine , cirrhosis , hepatorenal syndrome , pathogenesis , ejection fraction , cardiology , qt interval , cardiomyopathy , diastole , liver transplantation , cardiac function curve , heart failure , transplantation , blood pressure
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.