Copyright ©2014 Baishideng Publishing Group Co.
World J Hepatol. Jan 27, 2014; 6(1): 41-54
Published online Jan 27, 2014. doi: 10.4254/wjh.v6.i1.41
Table 1 Proposal for diagnostic and supportive criteria for cirrhotic cardiomyopathy agreed upon at a working party held at the 2005 World Congress of Gastroenterology
A working definition of cirrhotic cardiomyopathy
A cardiac dysfunction in patients with cirrhosis characterised by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease
Diagnostic criteria
Systolic dysfunction
Blunted increase in cardiac output with exercise, volume challenge or pharmacological stimuli
Resting EF < 55%
Diastolic dysfunction
E/A ratio < 1.0 (age-corrected)
Prolonged deceleration time (> 200 ms)
Prolonged isovolumetric relaxation time (> 80 ms)
Supportive criteria
Electrophysiological abnormalities
Abnormal chronotropic response
Electromechanical uncoupling/dyssynchrony
Prolonged QTc interval
Enlarged left atrium
Increased myocardial mass
Increased BNP and pro-BNP
Increased troponin I
Table 2 Comparison between acute and chronic hepatic complications of cardiac failure
Chronic congestive hepatopathyAcute ischemic hepatitis
AetiologyChronic heart failureAcute heart failure
PathophysiologyPerisinusoidal edemaTissue hypoxia
Increased lymph flowZone 3 necrosis
Zone 3: alternating necrosis and hemorrhage
Sinusoidal thrombosis
ManifestationsRight hypochondrial painAsymptomatic or nonspecific
Edema, ascites, jaundice(nausea, vomiting, jaundice, right hypochondrial pain)
Laboratory data
BilirubinMild increaseMarked elevation
ALT and ASTNormal mild elevationMarked elevation
LDHNormal or mild elevationMarked elevation
Prothrombin timeProlongedNormal or prolonged
ALPNormal or mild elevationIncreased
TraetmentACE inhibitorsOxygen therapy
b-blockersAvoid precipitating factors
DiureticInotropic agents with caution
AmiodaroneVasopressor with caution
Statins with cautionDiuretics in hypervolemia
PrognosisSlowly progressive courseBenign and usually self limited
Table 3 Diseases affecting both the liver and the heart concomitantly
Hepatic manifestationsCardiac manifestations
Allagile syndromeCholestasisCongenital heart defects
Situs Inversus totalisConcerns with liver or heart transplantation
SepsisAcute liver failureAcute heart failure
Hepatitis CHepatitisMyocarditis, cardiomyopathy
HIVHepatitis, granulomaMyocarditis , cardiomyopathy
MalariaHepatic necrosisCariac failure
Dengue feverHepatic necrosisMyocarditis
AmebiasisHepatitis, hepatic abscessPericarditis, effusion
Wilson diseaseCirrhosis, hepatitisLeft ventricular remodeling
HemochromatosisCirrhosis, hepatitisCardiomyopathy
SLESteatosis, hepatomegalyEndocarditis, pericarditis
AmyloidosisHepatomegaly, cholestasisCardiomyopathy
SarcoidosisGranuloma, cholestasisConduction defects, HF
Chronic alcoholismCirrhosisCariomyopathy
Grave’s diseaseHepatitis, cholestasisHF
Autoimmune hepatitisHepatitis, cirrhosisCarditis