[Cirrhotic cardiomyopathy – Clinically fact or academic curiosity? Review. Part 3: treatment]

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Cirrhotic Cardiomyopathy (CCM) is a complex condition in end-stage liver disease.
• Standard heart failure medications like ACE inhibitors and ARBs are not recommended for CCM due to its unique pathophysiology.
• Hepatic transplantation (HT) is the primary treatment for end-stage liver disease with CCM.

Purpose of the Study:

• To review the current management strategies for Cirrhotic Cardiomyopathy (CCM) in the context of end-stage liver disease.
• To discuss the role and limitations of medical therapies and interventional procedures like Transjugular Intrahepatic Porto-systemic Shunt (TIPS) in CCM.
• To highlight the efficacy and advancements in Hepatic Transplantation (HT) for CCM.

Main Methods:

• Review of current medical literature and clinical guidelines regarding CCM management.
• Analysis of the role of diuretics and non-selective beta-blockers in pre- and post-transplant care.
• Evaluation of contraindications for specific heart failure medications (ACEI, ARB, ARNI) in CCM.
• Discussion of the potential benefits and risks of TIPS in CCM patients.
• Assessment of outcomes and survival rates following HT for CCM.

Main Results:

• Diuretics and non-selective beta-blockers are crucial for medical management of CCM before and after HT.
• ACE inhibitors, ARBs, and ARNIs are generally contraindicated in CCM.
• TIPS may have indications in CCM, but further research is needed to clarify its benefits and risks.
• HT, despite being a demanding therapy, has shown significant improvements in QTc interval, diastolic, and systolic dysfunction.
• Survival rates after HT for CCM have improved due to advances in surgical techniques, intensive care, immunosuppression, and imaging, even in sicker patients.

Conclusions:

• Hepatic transplantation (HT) remains the most effective treatment for end-stage liver disease with Cirrhotic Cardiomyopathy (CCM).
• Careful patient selection and management, avoiding contraindicated medications, are essential.
• Ongoing research into interventional procedures like TIPS and continuous improvement in HT protocols are vital for optimizing outcomes in CCM.