Cardiomiopatía cirrótica – ¿Realidad clínica o simple curiosidad académica? Revisión. : Parte 1: definición, epidemiología, anatomía patológica y clínica

Hugo Ramos; Mario Altieri

doi:10.31053/1853.0605.v81.n1.44416

Autores/as

Hugo R. Ramos, M.D., Ph.D. Facultad de Ciencias MédicasUniversidad Nacional de Cordoba. Instituto Modelo de Cardiologia
Mario H. Altieri, MD Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

DOI:

https://doi.org/10.31053/1853.0605.v81.n1.44416

Palabras clave:

cirrosis hepática, cardiomiopatía, insuficiencia cardíaca, trasplante hepático

Resumen

La cirrosis avanzada puede provocar alteraciones miocárdicas que constituyen el síndrome de Cardiomiopatía Cirrótica definido como la disfunción cardíaca asociada con cirrosis hepática en ausencia de enfermedad cardíaca preexistente. Su prevalencia es variable de acuerdo a lo reportado por diferentes grupos de investigación debido a que puede mantenerse subclínica o latente hasta que la pone de manifiesto una situación de estrés como una cirugía, hemorragia, infección, trasplante hepático o shunt porto-sistémico intrahepático transyugular. El objetivo de esta revisión es discutir la definición, los fundamentos anátomo-patológicos, fisiopatología, manifestaciones clínicas, criterios de diagnóstico, importancia de los estudios con imágenes, relevancia clínica, tratamiento farmacológico y trasplante hepático.

Descargas

Los datos de descarga aún no están disponibles.

Biografía del autor/a

Hugo R. Ramos, M.D., Ph.D., Facultad de Ciencias MédicasUniversidad Nacional de Cordoba. Instituto Modelo de Cardiologia

Egresado de la Universidad Nacional de Córdoba. Especialista en Clínica Médica, Especialista en Cardiología (CMPC y UNC), Especialista en Medicina de Emergencias (CMPC). Doctor en Medicina y Cirugía FCM, UNC. Prof. Asociado en la Cátedra de Clínica Médica I, UHMI 2 del Hospital San Roque, FCM, UNC. Ex Jefe del Depto de Clínica Médica del Hospital Municipal de Urgencias de Córdoba, Cardiólogo en Instituto Modelo de Cardiología de Córdoba. Campo de investigación: biomarcadores cardíacos, insuficiencia cardíaca, amiloidosis cardíaca, cardiopatía isquémica. ORCID ID: https://orcid.org/0000-0001-6772-903X
Mario H. Altieri, MD, Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

Egresado de la Universidad Nacional de Córdoba. Especialista en Medicina Interna y Terapia Intensiva (CMPC), Especialista en Terapia Intensiva (Francia). Ex Prof. de Medicina Intensiva de la Universidad Católica de Córdoba. Ex Director del programa Medicob de trasplante de Hígado, Caen, Francia. Miembro fundador del Cirrhotic Cardiomyopathy Consortium. Ex Miembro del Comité Ejecutivo de la International Liver Transplant Society (ILTS) para problemas cardiovasculares y cirrosis. ORCID ID: https://orcid.org/0000-0003-4164-1771.

Referencias

1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022 Feb 22;145(8):e153-e639. Erratum in: Circulation. 2022 Sep 6;146(10):e141.

2. Izzy M, VanWagner LB, Lin G, Altieri M, Findlay JY, Oh JK, Watt KD, Lee SS; Cirrhotic Cardiomyopathy Consortium. Redefining Cirrhotic Cardiomyopathy for the Modern Era. Hepatology. 2020 Jan;71(1):334-345. doi: 10.1002/hep.30875. Epub 2019 Oct 11. Erratum in: Hepatology. 2020 Sep;72(3):1161.

3. Ruiz-del-Árbol L, Serradilla R. Cirrhotic cardiomyopathy. World J Gastroenterol. 2015 Nov 7;21(41):11502-21. doi: 10.3748/wjg.v21.i41.11502.

4. Kowalski HJ, Abelmann WH. The cardiac output at rest in Laennec's cirrhosis. J Clin Invest. 1953;32(10):1025–33. doi: 10.1172/JCI102813.

5. Regan TJ, Levinson GE, Oldewurtel HA, Frank MJ, Weisse AB, Moschos CB. Ventricular function in noncardiacs with alcoholic fatty liver: role of ethanol in the production of cardiomyopathy. J Clin Invest. 1969;48(2):397–407. doi: 10.1172/JCI105997.

6. Lee SS. Cardiac abnormalities in liver cirrhosis. West J Med. 1989;151(5):530–5.

7. Grose RD, Nolan J, Dillon JF, Errington M, Hannan WJ, Bouchier IA, Hayes PC: Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis. J Hepatol 1995,22:326-332. doi: 10.1016/0168-8278(95)80286-x.

8. Finucci G, Desideri A, Sacerdoti D, Bolognesi M, Merkel C, Angeli P, Gatta A: Left ventricular diastolic function in liver cirrhosis. Scand J Gastroenterol 1996, 31:279-284. doi: 10.3109/00365529609004879.

9. Pozzi M, Carugo S, Boari G, Pecci V, de Ceglia S, Maggiolini S, Bolla GB, Roffi L, Failla M, Grassi G, Giannattasio C, Mancia G. Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites. Hepatology. 1997 Nov;26(5):1131-7. doi: 10.1002/hep.510260507.

10. Kaur H, Premkumar M. Diagnosis and Management of Cirrhotic Cardiomyopathy. J Clin Exp Hepatol. 2022 Jan-Feb;12(1):186-199. doi: 10.1016/j.jceh.2021.08.016.

11. Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol. 2016 Jun 28;67(25):2996-3010. doi: 10.1016/j.jacc.2016.03.590.

12. Chahal D, Liu H, Shamatutu C, Sidhu H, Lee SS, Marquez V. Review article: comprehensive analysis of cirrhotic cardiomyopathy. Aliment Pharmacol Ther. 2021 May;53(9):985-998. doi: 10.1111/apt.16305.

13. Shahvaran SA, Menyhárt O, Csedrik L, Patai ÁV. Diagnosis and Prevalence of Cirrhotic Cardiomyopathy: A Systematic Review and Meta-analysis. Curr Probl Cardiol. 2021 Oct;46(10):100821. doi: 10.1016/j.cpcardiol.2021.100821.

14. Cesari M, Frigo AC, Piano S, Angeli P. Prevalence and prognostic value of cirrhotic cardiomyopathy as defined according to the proposed new classification. Clin Exp Hepatol. 2021 Sep;7(3):270-277. doi: 10.5114/ceh.2021.108708.

15. Razpotnik M, Bota S, Wimmer P, Hackl M, Lesnik G, Alber H, Peck-Radosavljevic M. The prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria. Liver Int. 2021 May;41(5):1058-1069. doi: 10.1111/liv.14769.

16. Ripoll C, Catalina MV, Yotti R, Olmedilla L, Pérez-Peña J, Lo Iacono O, Rincón D, García-Fernández MA, Bermejo J, Bañares R. Cardiac dysfunction during liver transplantation: incidence and preoperative predictors. Transplantation. 2008 Jun 27;85(12):1766-72. doi: 10.1097/TP.0b013e318172c936.

17. Merli M, Calicchia A, Ruffa A, Pellicori P, Riggio O, Giusto M, Gaudio C, Torromeo C. Cardiac dysfunction in cirrhosis is not associated with the severity of liver disease. Eur J Intern Med. 2013 Mar;24(2):172-6. doi: 10.1016/j.ejim.2012.08.007.

18. Caramelo C, Fernandez-Muñoz D, Santos JC, Blanchart A, Rodriguez-Puyol D, López-Novoa JM, Hernando L. Effect of volume expansion on hemodynamics, capillary permeability and renal function in conscious, cirrhotic rats. Hepatology. 1986 Jan-Feb;6(1):129-34. doi: 10.1002/hep.1840060125.

19. Gaskari SA, Liu H, D'Mello C, Kunos G, Lee SS. Blunted cardiac response to hemorrhage in cirrhotic rats is mediated by local macrophage-released endocannabinoids. J Hepatol. 2015 Jun;62(6):1272-7. doi: 10.1016/j.jhep.2015.01.021.

20. Ortiz-Olvera NX, Castellanos-Pallares G, Gómez-Jiménez LM, Cabrera-Muñoz ML, Méndez-Navarro J, Morán-Villota S, Dehesa-Violante M. Anatomical cardiac alterations in liver cirrhosis: an autopsy study. Ann Hepatol. 2011 Jul-Sep;10(3):321-6.

21. Lunseth JH, Olmstead EG, Abboud BB F. A study of heart disease in one hundred eight hospitalized patients dying with portal cirrhosis. AMA Arch Intern Med. 1958 Sep;102(3):405-13.doi: 10.1001/archinte.1958.00030010405009.

22. Wehmeyer MH, Heuer AJ, Benten D, Püschel K, Sydow K, Lohse AW, Lüth S. High Rate of Cardiac Abnormalities in a Postmortem Analysis of Patients Suffering From Liver Cirrhosis. J Clin Gastroenterol. 2015 Nov-Dec;49(10):866-72. doi: 10.1097/MCG.0000000000000323.

23. Wong F, Liu P, Lilly L, Bomzon A, Blendis L. Role of cardiac structural and functional abnormalities in the pathogenesis of hyperdynamic circulation and renal sodium retention in cirrhosis. Clin Sci (Lond). 1999 Sep;97(3):259-67.

24. Wong F, Girgrah N, Graba J, Allidina Y, Liu P, Blendis L. The cardiac response to exercise in cirrhosis. Gut. 2001 Aug;49(2):268-75. doi: 10.1136/gut.49.2.268.

25. Liu H, Nguyen HH, Yoon KT, Lee SS. Pathogenic Mechanisms Underlying Cirrhotic Cardiomyopathy. Front Netw Physiol. 2022 Apr 19;2:849253. doi: 10.3389/fnetp.2022.849253.

26. Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, Murray CJ, Naghavi M. Liver cirrhosis mortality in 187

countries between 1980 and 2010: a systematic analysis. BMC Med. 2014 Sep 18;12:145. doi: 10.1186/s12916-014-0145-y.

27. Salhab A, Amer J, Lu Y, Safadi R. Sodium+/taurocholate cotransporting polypeptide as target therapy for liver fibrosis. Gut. 2022 Jul;71(7):1373-1385. doi: 10.1136/gutjnl-2020-323345.

28. Zavecz JH, Battarbee HD. The role of lipophilic bile acids in the development of cirrhotic cardiomyopathy. Cardiovasc Toxicol. 2010 Jun;10(2):117-29. doi: 10.1007/s12012-010-9069-8.

29. Gorelik J, Harding SE, Shevchuk AI, Koralage D, Lab M, de Swiet M, Korchev Y, Williamson C. Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics. Clin Sci (Lond). 2002 Aug;103(2):191-200. doi: 10.1042/cs1030191.

30. Sheikh Abdul Kadir SH, Miragoli M, Abu-Hayyeh S, Moshkov AV, Xie Q, Keitel V, Nikolaev VO, Williamson C, Gorelik J. Bile acid-induced arrhythmia is mediated by muscarinic M2 receptors in neonatal rat cardiomyocytes. PLoS One. 2010 Mar 15;5(3):e9689. doi: 10.1371/journal.pone.0009689.

31. Desai MS, Mathur B, Eblimit Z, Vasquez H, Taegtmeyer H, Karpen SJ, Penny DJ, Moore DD, Anakk S. Bile acid excess induces cardiomyopathy and metabolic dysfunctions in the heart. Hepatology. 2017 Jan;65(1):189-201. doi: 10.1002/hep.28890.

32. Ma Z, Lee SS, Meddings JB. Effects of altered cardiac membrane fluidity on beta-adrenergic receptor signalling in rats with cirrhotic cardiomyopathy. J Hepatol. 1997 Apr;26(4):904-12. doi: 10.1016/s0168-8278(97)80259-0.

33. Glenn TK, Honar H, Liu H, ter Keurs HE, Lee SS. Role of cardiac myofilament proteins titin and collagen in the pathogenesis of diastolic dysfunction in cirrhotic rats. J Hepatol. 2011 Dec;55(6):1249-55. doi: 10.1016/j.jhep.2011.02.030.

34. Honar H, Liu H, Zhang ML, Glenn TK, Ter Keurs HEDJ, Lee SS. Impaired myosin isoform shift and calcium transients contribute to cellular pathogenesis of rat cirrhotic cardiomyopathy. Liver Int. 2020 Nov;40(11):2808-2819. doi: 10.1111/liv.14599.

35. Huo S, Shi W, Ma H, Yan D, Luo P, Guo J, Li C, Lin J, Zhang C, Li S, Lv J, Lin L. Alleviation of Inflammation and Oxidative Stress in Pressure Overload-Induced Cardiac Remodeling and Heart Failure via IL-6/STAT3 Inhibition by Raloxifene. Oxid Med Cell Longev. 2021 Mar 20;2021:6699054. doi: 10.1155/2021/6699054. Retraction in: Oxid Med Cell Longev. 2023 Dec 29;2023:9815047.

36. Huang X, Thansamay S, Yang K, Luo T, Chen S. Measurement of Exhaled Nitric Oxide in Cirrhotic Patients with Esophageal and Gastric Varices. Biomed Res Int. 2019 Nov 3;2019:9673162. doi: 10.1155/2019/9673162.

37. Liu H, Ma Z, Lee SS. Contribution of nitric oxide to the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats. Gastroenterology. 2000 May;118(5):937-44. doi: 10.1016/s0016-5085(00)70180-6.

38. Ansari U, Behnes M, Hoffmann J, Natale M, Fastner C, El-Battrawy I, Rusnak J, Kim SH, Lang S, Hoffmann U, Bertsch T, Borggrefe M, Akin I. Galectin-3 Reflects the Echocardiographic Grades of Left Ventricular Diastolic Dysfunction. Ann Lab Med. 2018 Jul;38(4):306-315. doi: 10.3343/alm.2018.38.4.306.

39. Zivlas C, Triposkiadis F, Psarras S, Giamouzis G, Skoularigis I, Chryssanthopoulos S, Kapelouzou A, Ramcharitar S, Barnes E, Papasteriadis E, Cokkinos D. Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3. Ther Adv Cardiovasc Dis. 2017 Nov;11(11):283-295. doi: 10.1177/1753944717727498.

40. Ma L, Liu X, Wu Q, Hu X, Liu H, Zhang J, Lee SS. Role of Anti-Beta-1-Adrenergic Receptor Antibodies in Cardiac Dysfunction in Patients with Cirrhotic Cardiomyopathy. J Cardiovasc Transl Res. 2022 Apr;15(2):381-390. doi: 10.1007/s12265-021-10161-5.

41. Ward CA, Ma Z, Lee SS, Giles WR. Potassium currents in atrial and ventricular myocytes from a rat model of cirrhosis. Am J Physiol. 1997 Aug;273(2 Pt 1):G537-44. doi: 10.1152/ajpgi.1997.273.2.G537.

42. Zardi EM, Abbate A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW, Afeltra A, Sanyal AJ. Cirrhotic cardiomyopathy. J Am Coll Cardiol. 2010 Aug 10;56(7):539-49. doi: 10.1016/j.jacc.2009.12.075. Erratum in: J Am Coll Cardiol. 2010 Sep 14;56(12):1000. Van Tassel, Benjamin W [corrected to Van Tassell, Benjamin W].

43. Marchetta S, Altieri M, Weil-Verhoeven D, Mouhat B, Piérard L, Thévenot T. La cardiomyopathie cirrhotique: de nouvelles approches diagnostiques. Hépato-Gastro et Oncologie Digestive 2021; 28 : 584-592.

44. Karagiannakis DS, Papatheodoridis G, Vlachogiannakos J. Recent advances in cirrhotic cardiomyopathy. Dig Dis Sci. 2015 May;60(5):1141-51. doi: 10.1007/s10620-014-3432-8.

45. Karagiannakis DS, Vlachogiannakos J, Anastasiadis G, Vafiadis-Zouboulis I, Ladas SD. Frequency and severity of cirrhotic cardiomyopathy and its possible relationship with bacterial endotoxemia. Dig Dis Sci. 2013 Oct;58(10):3029-36. doi: 10.1007/s10620-013-2693-y.

46. Ruíz-del-Árbol L, Achécar L, Serradilla R, Rodríguez-Gandía MÁ, Rivero M, Garrido E, Natcher JJ. Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology. 2013 Nov;58(5):1732-41. doi: 10.1002/hep.26509.

47. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice

Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239. doi: 10.1016/j.jacc.2013.05.019.

48. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, Anker SD, Atherton J, Böhm M, Butler J, Drazner MH, Michael Felker G, Filippatos G, Fiuzat M, Fonarow GC, Gomez-Mesa JE, Heidenreich P, Imamura T, Jankowska EA, Januzzi J, Khazanie P, Kinugawa K, Lam CSP, Matsue Y, Metra M, Ohtani T, Francesco Piepoli M, Ponikowski P, Rosano GMC, Sakata Y, Seferović P, Starling RC, Teerlink JR, Vardeny O, Yamamoto K, Yancy C, Zhang J, Zieroth S. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021 Mar;23(3):352-380. doi: 10.1002/ejhf.2115.