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Cirrhotic cardiomyopathy: review of pathophysiology and treatment

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Abstract

Cirrhotic cardiomyopathy is a cardiac condition observed in patients with cirrhotic regardless of the etiologies. It is characterized by the impaired systolic response to physical stress, diastolic dysfunction, and electrophysiological abnormalities, especially QT interval prolongation. Its pathophysiology and clinical significance has been a focus of various researchers for the past decades. The impairment of β-adrenergic receptor, the increase in endogenous cannabinoids, the presence of cardiosuppressants such as nitric oxide and inflammatory cytokines are the proposed mechanisms of systolic dysfunction. The activation of cardiac renin-angiotensin system and salt retention play the role in the development of cardiac hypertrophy and impaired diastolic function. QT interval prolongation, which is observed in 40–50 % of cirrhotic patients, occurs as a result of the derangement in membrane fluidity and ion channel defect. The increased recognition of this disease will prevent the complications of overt heart failure after procedures such as transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation. Better understandings of the pathogenesis and pathology of cirrhotic cardiomyopathy is crucial in developing more accurate diagnostic tools and specific treatments of this condition.

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Abbreviations

AC:

Adenylate cyclase

ATP:

Adenosine triphosphate

cAMP:

Cyclic adenosine monophosphate

cGMP:

Cyclic guanosine monophosphate

CO:

Carbon monoxide

HO:

Heme oxygenase

MPTPs:

Mitochondrial permeability transition pores

NO:

Nitric oxide

NOS:

Nitric oxide synthase

PDE2 :

Prostaglandin E2

PKA:

Protein kinase A

TNF-α:

Tumor necrosis factor-α

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Acknowledgements

This study is supported by K08 AA016570 from the NIH/NIAAA, 1I01CX000361-01 from the Veterans Affairs Research and Administration, Indiana University Research Support Fund Grant, and W81XWH-12-1-0497 from United States Department of Defense (All to S.L.).

Compliance with ethical requirements and Conflict of interest

All authors comply with the ethical policies in preparation of this manuscript. Maneerat Chayanupatkul and Suthat Liangpunsakul have nothing to disclose regarding conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA

    Maneerat Chayanupatkul

  2. Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Hospital, 550 University Boulevard, UH 4100, Indianapolis, IN, 46202-5149, USA

    Suthat Liangpunsakul

  3. Roudebush Veterans Administration Medical Center, Indiana University, Indianapolis, IN, USA

    Suthat Liangpunsakul

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  1. Maneerat Chayanupatkul
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Correspondence to Suthat Liangpunsakul.

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Chayanupatkul, M., Liangpunsakul, S. Cirrhotic cardiomyopathy: review of pathophysiology and treatment. Hepatol Int 8, 308–315 (2014). https://doi.org/10.1007/s12072-014-9531-y

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