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dc:titleJoint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics
dc:creatorRankovic, Ivan
dc:creatorBabic, Ivana
dc:creatorMartinov Nestorov, Jelena
dc:creatorBogdanovic, Jelena
dc:creatorStojanovic, Maja
dc:creatorTrifunović, Jovanka
dc:creatorPanic, Nikola
dc:creatorBezmarevic, Mihailo
dc:creatorJevtovic, Jelena
dc:creatorMicic, Dusan
dc:creatorDedovic, Vladimir
dc:creatorDjuricic, Nemanja
dc:creatorPilipovic, Filip
dc:creatorCurakova Ristovska, Elena
dc:creatorGlisic, Tijana
dc:creatorKostic, Sanja
dc:creatorStojkovic, Nemanja
dc:creatorJoksimovic, Nata
dc:creatorBascarevic, Mileva
dc:creatorBozovic, Aleksandra
dc:creatorElvin, Lewis
dc:creatorOnifrade, Ajibola
dc:creatorSiau, Keith
dc:creatorKoriakovskaia, Elizaveta
dc:creatorMilivojevic, Vladimir
dc:subjectcirrhotic cardiomyopathy
dc:subjectliver cirrhosis
dc:subjectcardiac dysfunction
dc:subjectportal hypertension
dc:subjectsplanchnic vasodilation
dc:subjectcardiac remodeling
dc:subjectinflammatory cytokines
dc:subjectendotoxemia
dc:subjectintestinal permeability
dc:subjectadrenal insufficiency
dc:subjectstress echocardiography
dc:subjectspeckle tracking echocardiography
dc:subjectdiuretics
dc:subjectbeta-blockers
dc:subjectheart failure
dc:subjectanti-inflammatory therapy
dc:subjectantioxidant therapy
dc:descriptionCirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae.
dc:publisherMultidisciplinary Digital Publishing Institute
dc:date2025
dc:typeinfo:eu-repo/semantics/article
dc:typeinfo:eu-repo/semantics/publishedVersion
dc:identifierhttps://stomatoloskifakultet.rs/nauka/publikacija/856
dc:identifierDOI 10.3390/medicina61010046
dc:identifierISSN 1010-660X
dc:sourceMedicina - Lithuania 61(1): 46
dc:languageen
dc:rightsinfo:eu-repo/semantics/closedAccess
dc:rightsSva prava zadržana