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End stage liver cardiomyopathy

Won-Jung Shin, Jun-Gol Song, In-Gu Jun, Young-Jin Moon, Hye-Mee Kwon, Kyeowoon Jung, Seon-Ok Kim, Gyu-Sam Hwang
BACKGROUND AND AIMS: Ventriculo-arterial coupling (VAC) reflects the interaction between ventricular performance and effective arterial load. Current criteria for cirrhotic cardiomyopathy focus only on cardiac function without addressing the effect of hyperdynamic, low-resistance circulation. We investigated alterations in VAC in cirrhotic patients and their associations with post-liver transplant all-cause mortality. METHODS: In this single institution cohort study, cirrhotic patients who underwent liver transplantation (LT) (n = 914) were retrospectively compared with healthy matched controls using noninvasively measured end-systolic ventricular elastance (Ees), arterial elastance (Ea), and VAC (Ea/Ees)...
September 26, 2016: Journal of Hepatology
F Carvalheiro, C Rodrigues, T Adrego, J Viana, H Vieira, C Seco, L Pereira, F Pinto, A Eufrásio, C Bento, E Furtado
BACKGROUND: Patients with liver cirrhosis may develop cirrhotic cardiomyopathy (CC), characterized by blunted contractile responsiveness to stress, diastolic dysfunction (DD), and electrophysiological abnormalities. It may adversely affect the long-term prognosis of these patients. METHODS: We conducted a retrospective analysis of patients undergoing liver transplantation (LT) for cirrhosis from January 2012 to June 2015. We analyzed demographic characteristics, the etiology of cirrhosis, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, the corrected QT (QTc) interval in the preoperative period, diastolic and systolic dysfunction, mortality and survival, and duration of mechanical ventilation and vasopressor support in the post-LT period...
January 2016: Transplantation Proceedings
Mara Barbosa, Joana Guardado, Carla Marinho, Bruno Rosa, Isabel Quelhas, António Lourenço, José Cotter
AIM: To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease. METHODS: A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected...
January 28, 2016: World Journal of Hepatology
H J Reich, M Awad, A Ruzza, M A De Robertis, D Ramzy, N Nissen, S Colquhoun, F Esmailian, A Trento, J Kobashigawa, L S Czer
PURPOSE: Combined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation. METHODS: All combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998-2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission...
November 2015: Transplantation Proceedings
Dimitrios S Karagiannakis, Jiannis Vlachogiannakos, Georgios Anastasiadis, Irini Vafiadis-Zouboulis, Spiros D Ladas
BACKGROUND AND PURPOSE: Left ventricular diastolic dysfunction (LVDD) constitutes the prominent characteristic of cirrhotic cardiomyopathy, but its relevance on the clinical course of cirrhotic patients has not been clearly defined. The aim of the study was to evaluate the relationship of LVDD with the severity and etiology of liver disease and to investigate whether it affects the outcome of cirrhotic patients. METHODS: Cardiac function of 45 cirrhotics was studied by a tissue Doppler imaging echocardiography...
October 2014: Hepatology International
Aparna Dalal
Patients with end stage liver disease (ESLD) have complex problems such as cirrhotic cardiomyopathy, coronary artery disease, hepatopulmonary syndrome (HPS), portopulmonary hypertension (POPH), hepatic encephalopathy, intracranial hypertension, (ICP), left ventricular outflow tract obstruction (LVOTO), high Model of end liver disease (MELD) scores, hyponatremia, and coagulopathies. The anesthesia management for liver transplantation can be very complex, dynamic and challenging. Anesthesia agents affect hepatic blood flow and anesthetic drug distribution, metabolism and elimination maybe altered in end stage liver disease...
January 2016: Transplantation Reviews
Kumud K Dhital, Arjun Iyer, Mark Connellan, Hong C Chew, Ling Gao, Aoife Doyle, Mark Hicks, Gayathri Kumarasinghe, Claude Soto, Andrew Dinale, Bruce Cartwright, Priya Nair, Emily Granger, Paul Jansz, Andrew Jabbour, Eugene Kotlyar, Anne Keogh, Christopher Hayward, Robert Graham, Phillip Spratt, Peter Macdonald
BACKGROUND: Orthotopic heart transplantation is the gold-standard long-term treatment for medically refractive end-stage heart failure. However, suitable cardiac donors are scarce. Although donation after circulatory death has been used for kidney, liver, and lung transplantation, it is not used for heart transplantation. We report a case series of heart transplantations from donors after circulatory death. METHODS: The recipients were patients at St Vincent's Hospital, Sydney, Australia...
June 27, 2015: Lancet
Søren Møller, Flemming Bendtsen
In patients with cirrhosis and portal hypertension, it is largely the frequency and severity of complications relating to the diseased liver, degree of portal hypertension and hemodynamic derangement that determine the prognosis. It can be considered as a multiple organ failure that apart from the liver involves the heart, lungs, kidneys, the immune systems and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation...
June 2015: Scandinavian Journal of Gastroenterology
Malte H Wehmeyer, Anika J Heuer, Daniel Benten, Klaus Püschel, Karsten Sydow, Ansgar W Lohse, Stefan Lüth
BACKGROUND: Cirrhotic cardiomyopathy is a recently defined cardiac disorder in patients with end-stage liver disease. The frequency and exact manifestations of cardiac changes in liver cirrhosis is unknown. GOALS: We aim to describe cardiac changes in a large autopsy study of patients with liver cirrhosis. STUDY: Postmortem data from 895 individuals with liver cirrhosis of different origin autopsied from 1995 to 2010 were analyzed. A total of 236 patients were excluded, mostly due to an advanced age above 70 years...
November 2015: Journal of Clinical Gastroenterology
Xiaopeng Li, Shanshan Yu, Lu Li, Donggang Han, Shejiao Dai, Ya Gao
OBJECTIVE: The purpose of our study is to investigate cirrhosis-related left ventricular remodeling and functional changes, further to analyze the correlations with model for end-stage liver disease (MELD) score. METHODS: A total of 89 cirrhotic patients were enrolled for study and subgrouped according to MELD score: ≤ 9, 10-19, and ≥ 20. Thirty healthy individuals were enrolled as controls. All study participants underwent cardiac assessment of the left ventricle with Doppler echocardiography; the parameters assessed included left ventricular-end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), cardiac output (CO), mitral flow velocity (VE/VA ratio), and E-wave deceleration time (DT)...
2014: International Journal of Clinical and Experimental Medicine
Maryjane Farr, Paul Christian Schulze
Patients with end-stage liver disease in need of liver transplantation increasingly are older with a greater burden of cardiac disease and other co-morbidities, which may increase perioperative risk and adversely affect long-term prognosis. Cirrhosis of any etiology manifests hemodynamically as a state of low systemic vascular resistance, with high peripheral, but low central blood volume, leading to a state of neurohormonal activation and high cardiac output, which may adversely affect cardiac reserve under extreme perioperative stress, aptly termed cirrhosis-associated or cirrhotic cardiomyopathy...
2014: Clinical Medicine Insights. Cardiology
Søren Møller, Jens H Henriksen, Flemming Bendtsen
In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. This affects both the haemodynamic and functional homeostasis of many organs and largely determines the course of the disease...
November 14, 2014: World Journal of Gastroenterology: WJG
Natig Gassanov, Evren Caglayan, Nasser Semmo, Gero Massenkeil, Fikret Er
Cardiac dysfunction is frequently observed in patients with cirrhosis, and has long been linked to the direct toxic effect of alcohol. Cirrhotic cardiomyopathy (CCM) has recently been identified as an entity regardless of the cirrhosis etiology. Increased cardiac output due to hyperdynamic circulation is a pathophysiological hallmark of the disease. The underlying mechanisms involved in pathogenesis of CCM are complex and involve various neurohumoral and cellular pathways, including the impaired β-receptor and calcium signaling, altered cardiomyocyte membrane physiology, elevated sympathetic nervous tone and increased activity of vasodilatory pathways predominantly through the actions of nitric oxide, carbon monoxide and endocannabinoids...
November 14, 2014: World Journal of Gastroenterology: WJG
Coskun Celtik, Ozlem Durmaz, Naci Oner, Taner Yavuz, Selim Gökce, Aysen Aydogan, Kemal Nisli, H Haldun Emiroglu, Rukiye E Ömeroglu, Semra Sökücü
BACKGROUND: Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT). METHODS: This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50)...
February 2015: Journal of Pediatric Gastroenterology and Nutrition
M Susan Mandell, Tamas Seres, JoAnn Lindenfeld, Scott W Biggins, David Chascsa, Brian Ahlgren, Michael Wachs, Kiran M Bambha
BACKGROUND: Acute intraoperative heart failure (HF) is a rare but often fatal complication of liver transplant surgery. Little is known about the clinical course or predictive variables. Our aims were to provide a detailed clinical description and conduct a systematic search for characteristics associated with intraoperative HF. METHODS: A matched case-control study of adults undergoing primary liver transplant from 2009 to 2011 was conducted. Cases showed new onset HF with an ejection fraction less than 50% during liver transplant surgery...
April 2015: Transplantation
Zankhana Raval, Matthew E Harinstein, James D Flaherty
End stage liver disease (ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may profoundly influence diagnostic and management strategies in the preoperative period. This review focuses on evidence-based diagnosis and management of coronary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifically, we address the underlying prevalence of cardiovascular disease states in the ESLD population, and relevant diagnostic criteria thereof...
August 21, 2014: World Journal of Gastroenterology: WJG
C M Lee, Y-T Lee, L-B Jeng, C-Y Chang, J Wei
BACKGROUND: Multiple-organ transplantation cases are rare, partly due to the shortage of donor organs. However, recent reports of outcomes of multiple-organ transplantations show encouraging survival rates for recipients as compared to single-organ transplant recipients. CASE REPORT: A 33-year-old female who was a known hepatitis B carrier and who had been diagnosed with peripartum dilated cardiomyopathy was experiencing end-stage heart failure. The patient received orthotopic heart transplantation...
April 2014: Transplantation Proceedings
Jeffrey A Robinson, David J Driscoll, Patrick W O'Leary, Harold M Burkhart, Joseph A Dearani, Richard C Daly, Brooks S Edwards, Sonja H Dahl, Jonathan N Johnson
OBJECTIVE: To report our single-center experience with patients who had cardiac and multiorgan transplantation for end-stage congenital heart disease (CHD). PATIENTS AND METHODS: We reviewed records for all patients with CHD who had undergone heart transplantation at Mayo Clinic, Rochester, Minnesota, from November 1, 1990, through June 30, 2012. Patients with cardiomyopathy were excluded, unless CHD was present. RESULTS: Overall, 45 patients had cardiac transplantation for end-stage CHD (mean age, 26...
April 2014: Mayo Clinic Proceedings
Maria L Yataco, Thomas Difato, Johannes Bargehr, Barry G Rosser, Tushar Patel, Jorge F Trejo-Gutierrez, Surakit Pungpapong, C Burcin Taner, Jaime Aranda-Michel
BACKGROUND & AIMS: Non-ischaemic cardiomyopathy (NIC) is an early complication of liver transplantation (LT). Our aims were to define the prevalence, associated clinical factors, and prognosis of this condition. METHODS: A retrospective study was performed on patients undergoing LT at our institution from January 2005 to December 2012. Patients who developed NIC were identified. Data collected included demographic and clinical data. RESULTS: A total 1460 transplants were performed in this period and seventeen patients developed NIC...
July 2014: Liver International: Official Journal of the International Association for the Study of the Liver
Soo Yong Lee, Jun Kim, Sang Hyun Lee, Jin Hee Choi, Yong Hyun Park, June Hong Kim, Kook Jin Chun
We report a case of atrial fibrillation-related tachycardia induced cardiomyopathy and ventricular fibrillation after liver transplantation in a 41-year-old man with end-stage liver failure. Atrial fibrillation and congestive heart failure occurred postoperatively. Cardiac arrests due to ventricular fibrillation occurred 6 months after the operation with subsequent implantations of an implantable cardioverter-defibrillator. Ventricular arrhythmias did not recur during the 18 months after normalization of heart functions with guideline-directed medical treatments...
December 2013: Korean Circulation Journal
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