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Diastolic dysfunction in cirrhosis

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Abstract

Development of esophageal varices, ascites, and hepatic nephropathy is among the major complications of cirrhosis. The presence of cirrhotic cardiomyopathy, which includes a left ventricular diastolic dysfunction (DD), seems to deteriorate the course of the disease and the prognosis. Increased stiffness of the cirrhotic heart may decrease the compliance and result in DD. The prevalence of DD in cirrhotic patients averages about 50 %. It can be evaluated by transmitral Doppler echocardiography, tissue Doppler echocardiography, and cardiac magnetic resonance imaging. There seems to be a relation between DD and the severity of liver dysfunction and the presence of ascites. After liver transplantation, DD worsens the prognosis and increases the risk of graft rejection, but DD improves after few months. Insertion of a transjugular intrahepatic portosystemic shunt increases left ventricular diastolic volumes, and DD is a predictor of poorer survival in these patients. Future studies should aim at disclosing pathophysiological mechanisms behind the developing of DD in cirrhosis in relation to patient characteristics, development of complications, treatment, and risk associated with interventional procedures.

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Abbreviations

AC:

Atrial contribution

ANP:

Atrial natriuretic peptide

BNP:

Brain natriuretic peptide

BRS:

Baroreflex sensitivity

CGRP:

Calcitonin gene-related peptide

CMR:

Cardiac magnetic resonance imaging

DD:

Left ventricular diastolic dysfunction

DDT:

Diastolic deceleration time

IL:

Interleukin

IR:

Isovolumetric relaxation phase

IVRT:

Isovolumetric relaxation time

LVEF:

Left ventricular ejection fraction

MELD:

Model of end-stage liver disease

PICD:

Post-paracentesis-induced circulatory dysfunction

RAAS:

Renin–angiotensin–aldosterone system

RF:

Rapid filling

SF:

Slow filling

TIPS:

Transjugular portosystemic shunt

TNF:

Tumor necrosis factor

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Acknowledgments

SM received a research grant from the Novo Nordisk Foundation.

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Authors and Affiliations

  1. Department of Clinical Physiology and Nuclear Medicine 260, Centre for Functional Imaging and Research, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Søren Møller, Signe Wiese & Hanne Halgreen

  2. Department of Cardiology, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Jens D. Hove

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  1. Søren Møller
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  2. Signe Wiese
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  3. Hanne Halgreen
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  4. Jens D. Hove
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Correspondence to Søren Møller.

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Møller, S., Wiese, S., Halgreen, H. et al. Diastolic dysfunction in cirrhosis. Heart Fail Rev 21, 599–610 (2016). https://doi.org/10.1007/s10741-016-9552-9

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