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[Morphologic and functional abnormalities of the cardiovascular system in patients with hepatic cirrhosis]
Federico Piscione1, Vincenzo Manganiello, Orazio Viola
1Cattedra di Cardiologia Università degli Studi Federico II Via S. Pansini, 5 80131 Napoli. piscione@unina.it
Insights
Liver cirrhosis causes cardiovascular changes, including a unique hyperdynamic circulation. This condition, driven by portal hypertension, significantly impacts prognosis and leads to severe complications in advanced liver disease.
Area of Science:
- Cardiovascular Medicine
- Hepatology
- Pathophysiology
Context:
- Liver cirrhosis involves significant cardiovascular system alterations.
- These abnormalities worsen with progressive portal hypertension and liver dysfunction.
Purpose:
- To elucidate the pathogenesis of cardiovascular changes in liver cirrhosis.
- To highlight the development of hyperdynamic circulation in this condition.
Summary:
- Cirrhotic hearts exhibit diastolic dysfunction and reduced exercise-induced myocardial response, potentially due to impaired beta-adrenergic function.
- Hyperdynamic circulation, characterized by increased cardiac output and reduced peripheral vascular resistance, is a hallmark of advanced cirrhosis, primarily linked to portal hypertension.
Impact:
- Understanding hyperdynamic circulation is crucial due to its adverse prognostic implications.
- This cardiovascular syndrome underlies severe complications in advanced liver cirrhosis, necessitating further research into its complex origins.
Abstract:
During liver cirrhosis many important changes occur in the cardiovascular system and these abnormalities appear more evident as portal hypertension and liver dysfunction progress. The cirrhotic heart develops a series of structural and functional abnormalities consisting in diastolic dysfunction and reduced myocardial reactivity during exercise, likely due to a diminished myocardial beta-adrenergic receptor function. Nevertheless, the peculiarity of the cardiovascular involvement during liver cirrhosis is represented by a progressive development of a hyperdynamic circulation that seems to be due to portal hypertension rather than to liver insufficiency. In fact, it has been hypothesized that this syndrome raise from the venous portal bed and is primarily determined by an increase in blood volume that leads to an enhanced cardiac output. Later, as liver cirrhosis progresses, new important pathogenetic elements occur and lead to a reduction in peripheral vascular resistances and to the full clinical expression of hyperdynamic circulation. The pathogenesis of hyperdynamic circulation is very interesting for scientific research because of the complex and still in part unknown origin. In addition, this syndrome has an important clinical meaning for its severely adverse prognostic value and it represents the pathogenetic background for a number of severe complications of advanced liver cirrhosis.