Cardiomiopatia cirrótica - ¿Realidade clínica ou simples curiosidades acadêmicas? Revisão.
Parte 3: tratamento
DOI:
https://doi.org/10.31053/1853.0605.v81.n3.44420Palavras-chave:
cirrose hepática, cardiomiopatía, tratamento, transplante de fígadoResumo
O tratamento da doença hepática terminal com Cardiomiopatia Cirrótica (CMC) e o transplante hepático (TH), no entanto o tratamento médico com a combinação de diuréticos e beta bloqueadores não seletivos antes e depois possuem um papel importante. A diferença da insuficiência cardíaca de outras etiologias, os inibidores da enzima convertidora (IECA), os bloqueadores do receptor de angiotensina 2 (ARA-2) ou os inibidores do receptor de angiotensina e de neprilisina (ARNI) não são recomendados devido a fisiopatologia particular da CMC. O shunt porto-sistémico intra-hepático transjugular (Transjugular intrahepatic porto-systemic shunt: TIPS) também pode ser indicado com possíveis benefícios e riscos, mas na CMC são necessários maiores exames. O TH e uma opção complexa, mas com maior eficácia e pode reverter o QTc do ECG e a disfunção diastólica e sistólica. Nas últimas décadas, apesar do aumento da complexidade nos pacientes (maior score MELD), com a melhoria das técnicas cirúrgicas, os cuidados intensivos, medicamentos imunossupressores e diagnostico por imagens há sobrevida há melhorado significativamente.
Downloads
Referências
Limas CJ, Guiha NH, Lekagul O, Cohn JN: Impaired left ventricular function in alcoholic cirrhosis with ascites. Ineffectiveness of ouabain. Circulation. 1974, 49:754-760.
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.
Lee SS, Marty J, Mantz J, Samain E, Braillon A, Lebrec D. Desensitization of myocardial beta-adrenergic receptors in cirrhotic rats. Hepatology. 1990 Sep;12(3 Pt 1):481-5.
Liu H, Naser JA, Lin G, Lee SS. Cardiomyopathy in cirrhosis: From pathophysiology to clinical care. JHEP Rep. 2023 Sep 23;6(1):100911.
Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling SC, Nadim MK, Wong F, Kim WR. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-1048.
Tapper EB, Parikh ND. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023 May 9;329(18):1589-1602.
Sehgal R, Singh H, Singh IP. Comparative study of spironolactone and eplerenone in management of ascites in patients of cirrhosis of liver. Eur J Gastroenterol Hepatol. 2020 Apr;32(4):535-539.
Pozzi M, Grassi G, Ratti L, Favini G, Dell'Oro R, Redaelli E, Calchera I, Boari G, Mancia G. Cardiac, neuroadrenergic, and portal hemodynamic effects of prolonged aldosterone blockade in postviral child A cirrhosis. Am J Gastroenterol. 2005 May;100(5):1110-6.
Wilcox CS, Testani JM, Pitt B. Pathophysiology of Diuretic Resistance and Its Implications for the Management of Chronic Heart Failure. Hypertension. 2020 Oct;76(4):1045-1054.
Sehgal R, Singh H, Singh IP. Comparative study of spironolactone and eplerenone in management of ascites in patients of cirrhosis of liver. Eur J Gastroenterol Hepatol. 2020 Apr;32(4):535-539.
Perakakis N, Bornstein SR, Birkenfeld AL, Linkermann A, Demir M, Anker SD, Filippatos G, Pitt B, Rossing P, Ruilope LM, Kolkhof P, Lawatscheck R, Scott C, Bakris GL; FIDELIO-DKD and FIGARO-DKD investigators. Efficacy of finerenone in patients with type 2 diabetes, chronic kidney disease and altered markers of liver steatosis and fibrosis: A FIDELITY subgroup analysis. Diabetes Obes Metab. 2024 Jan;26(1):191-200.
El-Bokl MA, Senousy BE, El-Karmouty KZ, Mohammed Iel K, Mohammed SM, Shabana SS, Shalaby H. Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites. World J Gastroenterol. 2009 Aug 7;15(29):3631-5.
Rodrigues SG, Mendoza YP, Bosch J. Beta-blockers in cirrhosis: Evidence-based indications and limitations. JHEP Rep. 2019 Dec 20;2(1):100063.
Yasunari K, Maeda K, Nakamura M, Watanabe T, Yoshikawa J, Asada A. Effects of carvedilol on oxidative stress in polymorphonuclear and mononuclear cells in patients with essential hypertension. Am J Med 2004;116:460–465.
Dandona P, Dhindsa S, Aijada A, Chaudhuri A. Classical anti-oxidants (scavengers) versus biological anti-oxidants (suppressors of ROS generation): a novel way to explain the anti-oxidant paradox. Metab Syndr Relat Disord 2005; 2:155–159.
Henriksen JH, Bendtsen F, Hansen EF, Møller S: Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval (QTc) in patients with cirrhosis. J Hepatol. 2004, 40:239-246.
Sersté T, Melot C, Francoz C, et al.: Deleterious effects of beta-blockers on survival in patients with cirrosis and refractory ascites. Hepatology. 2010, 52:1017-1022.
Silvestre OM, Farias AQ, Ramos DS, Furtado MS, Rodrigues AC, Ximenes RO, de Campos Mazo DF, Yoshimura Zitelli PM, Diniz MA, Andrade JL, Strunz C, Friedmann AA, Lee SS, Carrilho FJ, D'Albuquerque LAC, Bacal F. β-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial. Eur J Gastroenterol Hepatol. 2018 Aug;30(8):930-937.
Villanueva C, Albillos A, Genesca J, Garcia-Pagan JC, Calleja JL, Aracil C, et al. Beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2019;393(10181):1597–1608.
Busk TM, Bendtsen F, Poulsen JH, Clemmesen JO, Larsen FS, Goetze JP, Iversen JS, Jensen MT, Møgelvang R, Pedersen EB, Bech JN, Møller S. Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018 Feb 1;314(2):G275-G286.
Huonker M, Schumacher YO, Ochs A, Sorichter S, Keul J, Rössle M. Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt. Gut. 1999 May;44(5):743-8.
Russo MW, Jacques PF, Mauro M, Odell P, Brown RS Jr. Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt. Liver Transpl. 2002 Mar;8(3):271-7.
Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, Meregaglia D, Nicolini A. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut. 2007 Jun;56(6):869-75.
Braverman AC, Steiner MA, Picus D, White H: High-output congestive heart failure following transjugular intrahepatic portal-systemic shunting. Chest 1995, 107:1467-1469.
Gines P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodes J: Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002, 123:1839-1847.
Rabie RN, Cazzaniga M, Salerno F, Wong F. The use of E/A ratio as a predictor of outcome in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 2009 Oct;104(10):2458-66.
Torregrosa M, Aguadé S, Dos L, Segura R, Gónzalez A, Evangelista A, Castell J, Margarit C, Esteban R, Guardia J, Genescà J. Cardiac alterations in cirrhosis: reversibility after liver transplantation. J Hepatol. 2005 Jan;42(1):68-74.
Bal JS, Thuluvath PJ. Prolongation of QTc interval: relationship with etiology and severity of liver disease, mortality and liver transplantation. Liver Int. 2003 Aug;23(4):243-8.
Adigun AQ, Pinto AG, Flockhart DA, Gorski JC, Li L, Hall SD, Chalasani N. Effect of cirrhosis and liver transplantation on the gender difference in QT interval. Am J Cardiol. 2005 Mar 1;95(5):691-4.
Sonny A, Ibrahim A, Schuster A, Jaber WA, Cywinski JB. Impact and persistence of cirrhotic cardiomyopathy after liver transplantation. Clin Transplant. 2016 Sep;30(9):986-93.
Dowsley TF, Bayne DB, Langnas AN, Dumitru I, Windle JR, Porter TR, Raichlin E. Diastolic dysfunction in patients with end-stage liver disease is associated with development of heart failure early after liver transplantation. Transplantation. 2012 Sep 27;94(6):646-51.
Mittal C, Qureshi W, Singla S, Ahmad U, Huang MA. Pre-transplant left ventricular diastolic dysfunction is associated with post transplant acute graft rejection and graft failure. Dig Dis Sci. 2014 Mar;59(3):674-80.
Rahman S, Mallett SV. Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients. World J Hepatol. 2015 Mar 27;7(3):507-20.
Chen Y, Chan AC, Chan SC, Chok SH, Sharr W, Fung J, Liu JH, Zhen Z, Sin WC, Lo CM, Tse HF, Yiu KH. A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation. J Cardiol. 2016 Feb;67(2):140-6.
Gajanana D, Gupta S, Koshkelashvili N, Rubio M, Bhalla V, Amanullah A. Electrocardiographic and echocardiographic changes in patients undergoing liver transplant stratified by outcomes. Int J Cardiol. 2016 Nov 15;223:699-700.
Qureshi W, Mittal C, Ahmad U, Alirhayim Z, Hassan S, Qureshi S, Khalid F. Clinical predictors of post-liver transplant new-onset heart failure. Liver Transpl. 2013 Jul;19(7):701-10.
Sonny A, Govindarajan SR, Jaber WA, Cywinski JB. Systolic heart failure after liver transplantation: Incidence, predictors, and outcome. Clin Transplant. 2018 Mar;32(3):e13199.
Fayek SA, Quintini C, Chavin KD, Marsh CL. The Current State of Liver Transplantation in the United States: Perspective From American Society of Transplant Surgeons (ASTS) Scientific Studies Committee and Endorsed by ASTS Council. Am J Transplant. 2016 Nov;16(11):3093-3104.
Baganate F, Beal EW, Tumin D, Azoulay D, Mumtaz K, Black SM, Washburn K, Pawlik TM. Early mortality after liver transplantation: Defining the course and the cause. Surgery. 2018 Oct;164(4):694-704.
Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY). 2021 Jan;46(1):43-67.
(2019) United Network for Organ Sharing Organ Procurement and Transplantation Network
Josefsson A, Fu M, Allayhari P, Björnsson E, Castedal M, Olausson M, Kalaitzakis E. Impact of peri-transplant heart failure & left-ventricular diastolic dysfunction on outcomes following liver transplantation. Liver Int. 2012 Sep;32(8):1262-9.
Snowden CP, Hughes T, Rose J, Roberts DR. Pulmonary edema in patients after liver transplantation. Liver Transpl. 2000 Jul;6(4):466-70.
Lui JK, Spaho L, Holzwanger E, Bui R, Daly JS, Bozorgzadeh A, Kopec SE. Intensive Care of Pulmonary Complications Following Liver Transplantation. J Intensive Care Med. 2018 Nov;33(11):595-608.
Watt KD, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant. 2010 Jun;10(6):1420-7.
Izzy M, Soldatova A, Sun X, Angirekula M, Mara K, Lin G, Watt KD. Cirrhotic Cardiomyopathy Predicts Posttransplant Cardiovascular Disease: Revelations of the New Diagnostic Criteria. Liver Transpl. 2021 Jun;27(6):876-886.
Spann A, Coe C, Ajayi T, Montgomery G, Shwetar M, Oje A, Annis J, Slaughter JC, Alexopoulos S, Brittain E, Izzy M. Cirrhotic cardiomyopathy: Appraisal of the original and revised criteria in predicting posttransplant cardiac outcomes. Liver Transpl. 2022 Aug;28(8):1321-1331.
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.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Universidad Nacional de Córdoba
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
A geração de trabalhos derivados é permitida, desde que não seja feita para fins comerciais. O trabalho original não pode ser usado para fins comerciais.
Como Citar
