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Recent Advances in Cirrhotic Cardiomyopathy

机译：肝硬化性心肌病的最新进展

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Cirrhotic cardiomyopathy, a cardiac dysfunction presented in patients with cirrhosis, represents a recently recognized clinical entity. It is characterized by altered diastolic relaxation, impaired contractility, and electrophysiological abnormalities, in particular prolongation of the QT interval. Several mechanisms seem to be involved in the pathogenesis of cirrhotic cardiomyopathy, including impaired function of beta-receptors, altered transmembrane currents, and overproduction of cardiodepressant factors, like nitric oxide, tumor necrosis factor alpha, and endogenous cannabinoids. Diastolic dysfunction is the first manifestation of cirrhotic cardiomyopathy and reflects the increased stiffness of the cardiac mass, which leads to delayed left ventricular filling. On the other hand, systolic incompetence is presented later, is usually unmasked during pharmacological or physical stress, and predisposes to the development of hepatorenal syndrome. The prolongation of QT is found in about 50 % of cirrhotic patients, but rarely leads to fatal arrhythmias. Cirrhotics with blunted cardiac function seem to have poorer survival rates compared to those without, and the risk is particularly increased during the insertion of transjugular intrahepatic portosystemic shunt or liver transplantation. Till now, there is no specific treatment for themanagement of cirrhotic cardiomyopathy. New agents, targeting to its pathogenetical mechanisms, may play some role as future therapeutic options.
机译：肝硬化性心肌病是一种在肝硬化患者中表现出的心脏功能障碍，代表了最近公认的临床实体。其特点是舒张期舒张改变，收缩力降低和电生理异常，特别是QT间隔延长。肝硬化性心肌病的发病机制似乎涉及多种机制，包括β受体功能受损，跨膜电流改变以及心脏抑制因子的过量产生，如一氧化氮，肿瘤坏死因子α和内源性大麻素。舒张功能障碍是肝硬化性心肌病的首个表现，反映出心脏质量增加，导致左心室充盈延迟。另一方面，收缩期功能不全较晚出现，在药理或生理压力时通常不会被掩盖，并且容易发展为肝肾综合征。在约50％的肝硬化患者中发现QT延长，但很少导致致命性心律失常。与没有心功能不全的肝硬化患者相比，心功能不全的肝硬化患者的生存率较差，在经颈静脉肝内门体分流术或肝移植的过程中，风险尤其增加。迄今为止，还没有针对肝硬化性心肌病的治疗方法。针对其致病机制的新药可能会作为未来的治疗选择发挥作用。

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