CIRRHOTIC CARDIOMYOPATHY - GETTING TO THE HEART OF THE MATTER

In cirrhosis, cardiac contractile function has been extensively docume nted to be abnormal. At baseline, cardiac output is increased, and thi s is one of the characteristics of hyperdynamic circulation, However, when cirrhotic patients are challenged by pharmacological or physiolog ical stress, ventricular hyporesponsiveness is revealed, Similar patte rns have been noted in cirrhotic animal models, This phenomenon has be en termed ''cirrhotic cardiomyopathy.'' Although alcohol abuse may con tribute to some cases of cirrhotic cardiomyopathy, it has been clearly documented to occur even in the absence of alcohol ingestion, Diminis hed myocardial p-adrenergic receptor signal transduction function, pos sibly caused by a persistent elevation in norepinephrine content, has been shown to play an important role, Alteration in cardiac plasma mem brane properties due to impaired lipid metabolism is also crucial. Oth er possible pathogenic factors are reviewed, including accumulation of cardiodepressant substances caused by hepatocellular insufficiency, a nd ventricular overload secondary to increased blood volume and hyperd ynamic circulation, Because the cardiac reserve function is borderline in patients with cirrhosis, cardiovascular status should be carefully monitored, especially when patients undergo stresses such as liver tr ansplantation or portosystemic shunting procedures.