scholarly journals A STUDY OF ECHOCARDIOGRAPHIC CHANGES IN PATIENTS WITH CIRRHOSIS OF LIVER

2021 ◽  
Vol 9 (11) ◽  
pp. 833-835
Author(s):  
Muvva Naga Pradeep ◽  
◽  
Gonaboyina Deepak Srinivas ◽  
Keyword(s):  
Pericardial Effusion ◽  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Disease Risk ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cirrhotic Cardiomyopathy ◽  
Cardiac Abnormalities ◽  
2D Echocardiography ◽  
Study Population

Background/Aims: Cirrhosis is associated with a significant number of cardiac abnormalities but, the information available is scanty about the changes associated with it in India. Which include increased cardiac output, increased wall thickness of cardiac chambers, left ventricular diastolic dysfunction, and PAH. These cardiac abnormalities in patients with Cirrhosis have been termed as Cirrhotic Cardiomyopathy. Cirrhotic Cardiomyopathy may be a significant cause of morbidity and mortality in patients with Cirrhosis. With the advent of increased liver transplantation in India, this entity may have an impact on transplantation success. The present study aims to evaluate the cardiac abnormalities in patients with cirrhosis using 2D Echocardiography to detect the occurrence of LV dysfunction, pulmonary hypertension, pericardial effusion, and to assess the contribution of cardiac dysfunction on mortality, if any. Methodology: Thirty patients with Cirrhosis (alcoholic and non-alcoholic) were enrolled. Thirty age and sex-matched controls without cardiovascular disease were included for comparison. Data collection was done by clinical history taking, examination, and investigations. All subjects underwent Echo study was at 0, 6 and12 months and controls at the start of the study. Observations and Results: 1. The mean age of study group was 54.5 ± 15 yrs among them, males constituted 93 % of the study population, the majority of patients were in Child class B (43.3%), and Child A (40%). None of the study population died during follow up. 2. The salient Echocardiographic abnormalities noted in the study population were a) Interventricular septal thickness showed significant change compared to control (9.80 ± 1.06 vs. 8.00 ± 1.00mm mm). b) Doppler echocardiography detected elevated pulmonary arterial pressure (PAP) in the study population compared to control (20.73 ±2.43mm Hg vs.18.26 ± 2.1mm Hg). c) Diastolic dysfunction occurred in the form of increased Deceleration time (223.17 ± 13.93 ms vs. 190.83 ± 14.0ms) and increased E: A ratio (1.10±0.1 vs. 1.04±0.12) was noted in subjects with Cirrhosis. Two of the study subjects had pericardial effusion. (6.7%) 3. There is no evidence of systolic dysfunction noted in the study population. 4. There is no correlation between the severity of Cirrhosis and echocardiographic changes. 5. There were no differences in echo parameters among patients with alcoholic or non-alcoholic etiology of Cirrhosis. 6. There was no fatality recorded due to cardiac dysfunction Conclusion: 1. This study demonstrates that Indian patients with cirrhosis do have diastolic dysfunction. In the absence of other cardiac disease risk factors, this dysfunction can be attributed only to cirrhotic cardiomyopathy. 2. Echocardiography plays a significant role in detecting early cardiac changes in cirrhosis however, these changes do not seem to be a predictor of increased mortality in cirrhosis patients.

scholarly journals Echocardiographic Assessment of Cardiac Function in Liver Cirrhosis: A Cross-sectional Study

2021 ◽  
Author(s):  
Apoorva Nirmal ◽  
Gajendra Agrawal ◽  
Sunil Kumar ◽  
Sourya Acharya ◽  
Akshay Dafal ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Systolic Dysfunction ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
2D Echocardiography

Introduction: Echocardiography is a noninvasive method to assess the cardiac dysfunction in liver cirrhosis. Early detection of cardiac dysfunction helps prevent morbidity in patients undergoing haemodynamics altering procedures like liver transplant or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) or those who have haematemesis. Aim: This study had been planned to assess the cardiac dysfunction and its incidence among patients of liver cirrhosis. Materials and Methods: In this cross-sectional study total of 150 individuals with liver cirrhosis were enrolled and cardiac assessment was done in the form of systolic and diastolic dysfunction by 2D Echocardiography. It was correlated with the aetiology and severity of liver cirrhosis was assessed by Child Pugh’s criteria. The grading of diastolic dysfunction was done on the basis of Early/Late (E/A) Left Ventricular (LV) filling ratio as Grade I (impaired relaxation pattern) E/A<0.8, Grade II (Pseudo normal) as E/A 0.8-1.5, and Grade III (Restrictive filling) E/A >2. Statistical analysis was done by using Chi-square test and Pearson’s Correlation Coefficient and p<0.05 is considered as level of significance. Results: Out of the 150 patients of liver cirrhosis, cardiac dysfunction was noted in 51. Among 93 (62%) patients who had alcoholic aetiology, 4 (44.4%) had systolic dysfunction whereas 29 (69.04%) had diastolic dysfunction. Among 9 patients of Left Ventricular (LV) systolic dysfunction 2 (22.2%) patients were in grade A Child Pugh, 4 (44.4%) in grade B and 3 (33.4%) in grade C, all being statically significant (r=0.195; p=0.017). LV diastolic dysfunction was seen in 17 (20.2%) of Grade A, 14 (25%) of Grade B and 11 (100%) of Grade C of Child Pugh Score, all being statistically significant and well correlated according to severity (r=0.199; p=0.004). Conclusion: The cardiac dysfunction was directly correlated with severity of liver cirrhosis according to Child Pugh scoring criteria thereby suggesting that possible cardiac changes were due to cirrhosis and not alcohol.

Diastolic dysfunction is associated with anaemia in patients with Type II diabetes

2005 ◽  
Vol 110 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Piyush M. Srivastava ◽  
Merlin C. Thomas ◽  
Paul Calafiore ◽  
Richard J. MacIsaac ◽  
George Jerums ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Type Ii Diabetes ◽  
Systolic Dysfunction ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Type Ii ◽  
Increased Risk ◽  
Patients With Diabetes

Anaemia is common in patients with diabetes and associated with an increased risk of diabetic complications. Although the role of anaemia in heart failure is established, we hypothesize that anaemia also contributes to an increased risk of cardiac dysfunction in patients with Type II diabetes. In the present study, 228 consecutive adults with diabetes were investigated using transthoracic echocardiography. Echocardiographic parameters were correlated with the Hb (haemoglobin) level and adjusted for other risk factors for cardiac dysfunction using multivariate analysis. More than one in five patients (23%) had anaemia, which was an independent risk factor for cardiac dysfunction on echocardiography. Over one-third of all patients with evidence of abnormal cardiac function (diastolic and/or systolic dysfunction) on echocardiography had anaemia compared with <5% of patients with normal echocardiographic findings. Most patients with anaemia had cardiac dysfunction (94%), with the major abnormality being diastolic dysfunction associated with an increased left ventricular mass and impaired relaxation indices. A continuous association between diastolic function and Hb was also observed in patients without anaemia. In patients with a history of cardiovascular disease, systolic dysfunction was twice as common in patients with anaemia. Anaemia was also correlated with plasma markers of cardiac risk, including BNP (brain natriuretic peptide), CRP (C-reactive protein) and AVP (arginine vasopressin). Notably, the predictive utility of these markers was eliminated after adjusting for Hb. Consequently, the inexpensive measurement of Hb may be a useful tool to identify diabetic patients at increased risk of cardiac dysfunction.

scholarly journals Echocardiographic Assessment of Cardiac Dysfunction in Patients of Chronic Kidney Disease on Maintenance Hemodialysis

2019 ◽  
Vol 17 (2) ◽  
pp. 35-38
Author(s):  
Shyam Kumar BK ◽  
S.D. Bassi ◽  
Alok Kumar Sah ◽  
Devendra Acharya
Keyword(s):  
Chronic Kidney Disease ◽  
Heart Disease ◽  
Kidney Disease ◽  
Pericardial Effusion ◽  
Diastolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Lv Diastolic Dysfunction

Objectives: The Aim of this study to assess and analyze the echocardiographic changes in chronic kidney disease patients on maintenance hemodialysis. Material and methods: We Performed Prospective study of echocardiographic changes in chronic kidney disease (CKD) patients undergoing maintenance hemodialysis at our institute. We performed M-mode echocardiography in 80 CKD patients without obvious clinical evidence of coronary artery disease, Valvular heart disease, congenital heart disease. Data was collected from November 2018 to Nov 2019. Results: 80 Patients Undergoing Hemodialysis were included in our study, out of them Echocardiography finding shown LV dilation and diastolic dysfunction in 39 (48.75%), left ventricular hypertrophy (LVH) in 41 (51.25%), systolic dysfunction and pericardial effusion in 22 (27.5%) and 11 (13.75%) patients respectively. RWMA was present in 10% and Valvular calcification was seen in 5 patients. In sub-group of patients with Hb<10 gm%, LVH was present in 32 (78.05%) vs 9 (21.95%) in patient group with Hb ≥ 10 gm% (p <0.01). Other Sub Group of Patients with BP > 140/90mmhg, LVH Was Present in 34 (82.92%) vs 7 (17.08%) in patients group with BP< 140/90 mm hg (p=0.02). In both sub group p value for systolic dysfunction, RWMA & pericardial effusion is statistically not significant. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH.  

Abstract 11033: Association of Albuminuria With Cardiac Dysfunction in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Echocardiographic Study of Latinos (Echo-SOL) Ancillary Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David B Hanna ◽  
Shuo Xu ◽  
Michal L Melamed ◽  
Franklyn Gonzalez ◽  
Robert C Kaplan ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Hispanic Americans ◽  
Systolic Dysfunction ◽  
Population Sample ◽  
Population Based ◽  
Left Ventricular ◽  
Health Study ◽  
Ancillary Study ◽  
Urine Albumin

Introduction: Higher urinary albumin has been associated with cardiac dysfunction in the general population. The generalizability of these findings to Hispanics/Latinos, a group in which ethnic CVD disparities have been documented, is unknown. Methods: Echo-SOL is an ancillary study of the HCHS/SOL, a population-based study of Hispanics/Latinos across 4 US sites. Echo-SOL participants underwent standard echocardiography. Urine albumin-to-creatinine ratio (UACR) was used to assess albuminuria and categorized as normal and high normal (based on the midpoint of values below microalbuminuria), microalbuminuria (≥17 mg/g for men; ≥25 for women), and macroalbuminuria (≥250; ≥355). Outcomes included left ventricular (LV) hypertrophy (using standard sex-specific cutpoints for LV mass index), LV systolic dysfunction (EF<50%), and any LV diastolic dysfunction. We assessed the association of UACR with cardiac dysfunction, adjusting for demographics (sex, age, Hispanic/Latino background) and cardiometabolic factors. Results: The study sample consisted of 1,525 participants (median age 54, female 65%, median BMI 29, diabetes 27%). Overall, 43% had normal UACR, 43% high normal UACR, 12% microalbuminuria, and 2% macroalbuminuria. The prevalence of LV hypertrophy was 13%, LV systolic dysfunction 3%, and diastolic dysfunction 59%. After adjustment, both micro- and macroalbuminuria were significantly associated with LV hypertrophy but not LV systolic dysfunction (Table). Increasing levels of albuminuria, even at high normal levels, were significantly associated with greater diastolic dysfunction. Conclusions: Higher UACR was associated with LV hypertrophy and diastolic dysfunction in the largest known population sample of US Hispanic/Latinos. These findings suggest that screening and detection of even high normal UACR could be of value to guide CVD prevention efforts among Hispanic Americans, who may represent an especially vulnerable population.

Cardiac Abnormalities in Children with Pre-Dialysis Chronic Kidney Disease in a Resource-Limited Setting: A Cross-Sectional Observational Study

2021 ◽  
Vol 67 (4) ◽  
Author(s):  
Naveen Bhagat ◽  
Lesa Dawman ◽  
Sanjeev Naganur ◽  
Karalanglin Tiewsoh ◽  
Basant Kumar ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Observational Study ◽  
Diastolic Dysfunction ◽  
Serum Calcium ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Cardiac Abnormalities ◽  
Lv Diastolic Dysfunction

Abstract Background Cardiovascular disease is the leading cause of morbidity and mortality in children with chronic kidney disease (CKD). We aim to estimate the prevalence of cardiac abnormalities in children up to age 16 years with CKD and their association with various risk factors. Methods This cross-sectional observational study was conducted on 107 CKD children. We assessed the systolic and diastolic function using 2D echocardiographic evaluation and M-mode measurements of the left ventricle (LV) indexed for BSA and z-scores were calculated. Results were compared with age, sex, stage of CKD, anaemia, estimated glomerular filtration rate (eGFR) and various laboratory parameters. Results LV diastolic dysfunction was seen in 88%, followed by increased LV dimensions in 33.6%, LV systolic dysfunction in 16%, right ventricle systolic dysfunction in 11.2% while increased pulmonary artery (PA) systolic pressure was seen in 9.3% of cases. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin levels. Left ventricular hypertrophy correlated directly with parathormone while inversely with eGFR, serum calcium and haemoglobin. Ejection fraction directly correlated to eGFR and serum calcium while inversely related to parathormone. Left PA pressure directly correlated with age and inversely with eGFR. Right ventricular systolic function assessed by tricuspid annular plane systolic excursion correlated inversely with haemoglobin. Conclusion LV diastolic dysfunction and increased LV dimensions were the most common cardiac abnormality in children with CKD. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin. Diastolic dysfunction positively correlated with serum creatinine and parathormone levels.

Subclinical Diastolic Dysfunction and Its Correlation with Laboratory Parameters in Type 2 Diabetes Mellitus in India: A Case Control Study

2018 ◽  
Vol 25 (2) ◽  
pp. 157-164
Author(s):  
◽  
Rajesh Kumar Meena ◽  
Sourabh Sharma ◽  
Soumya Sudharsan ◽  
Priyanka Kumari
Keyword(s):  
Diabetes Mellitus ◽  
Diastolic Dysfunction ◽  
Systolic Dysfunction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Left Ventricular ◽  
Patients With Diabetes ◽  
Study Population ◽  
Diabetic Population

Abstract Background: This study was conducted to evaluate left ventricular dysfunction in diabetics and to find correlation with glycemic control and biochemical parameters compared to non-diabetic population. Methods: Thirty type 2 diabetics and thirty nondiabetic controls were recruited. Age, sex, body mass index of the controls were matched. Results: Mean duration of diabetes mellitus in study population was 10.97± 4.01years. Among study population both cases and controls had ejection fraction >55%( no systolic dysfunction). Among cases(n=16) 53.3% were having mean E/A ratio <1 and(n=14) 46.67% were had mean E/A ratio >1. In controls all of them had mean E/A ratio above 1. This difference of mean E/A ratio among cases and controls was statistically significant (p<0.001). Among patients with diabetes, 9.09% cases with a HbA1cbetween 6-7%, 33.33% between 7.1-8%, respectively 100% of cases with HbA1c>8.1% had diastolic dysfunction the differences between groups being statistically significant (p<0.001). Low density lipoprotein( LDL) was weakly and negative correlated with E/A ratio (r = - 0.38) while fasting blood sugar (r = -0.53) respectively Hemoglobin A1c (r = -0.66) were moderately and negatively correlated. All these correlations were statistically significant. Conclusion: Subclinical diastolic dysfunction is prevalent among diabetic population. Diastolic dysfunction in patients with diabetes was correlated with FBS, HbA1C and LDL.

Abstract 283: Western Diet Induces Diastolic Dysfunction Linked to Impaired Cardiac Lipid Storage Dynamics That Predate Systolic Dysfunction

2020 ◽  
Vol 127 (Suppl_1) ◽  
Author(s):  
E Douglas K Lewandowski ◽  
Andrew N Carley ◽  
E Douglas D Lewandowski
Keyword(s):  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Western Diet ◽  
Lipid Storage ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Lipid ◽  
Lipid Dynamics

Western diet (WD), containing high fat and high refined sugar, is associated with increased risk of cardiovascular disease. However, mechanisms linking WD to cardiomyopathy are far from understood. We hypothesize that WD induces cardiac dysfunction by dysregulation of cardiac lipid dynamics. Adult C57BL/6J mice were fed with either standard chow (CON, fat 4.5 %, sucrose 0%) or western diet (WD, fat 45%, sucrose 21%). At 20 weeks, WD mice exhibited higher body mass, reduced glucose tolerance, and increased isovolumetric relaxation time (IVRT), with no systolic dysfunction vs. CON. However, at 24 weeks, WD caused both systolic and diastolic dysfunction with decreases in left ventricular ejection fraction (66±2% CON vs. 54±2 WD, P <0.05) and fractional shortening (35±2% CON vs. 27±1 WD), with elevated IVRT and E/E’ ratio vs CON. Real time, dynamic-mode 13 C NMR and endpoint LC/MS of isolated perfused hearts supplied 13 C palmitate and 13 C oleate, with unlabeled glucose and lactate, revealed elevated TG content (28% increase vs. CON) with reduced TG turnover in WD hearts (35% decrease vs. CON), concurrent with early diastolic dysfunction at 20 weeks and preceding systolic dysfunction at 24 weeks. WD induced lower content of the TG lipase, ATGL (48% vs. CON), with no change in the TG synthase, DGAT1, suggesting elevated cardiac TG and lower TG turnover are due to reduced TG hydrolysis and not TAG synthesis. Impaired lipid storage dynamics can cause increased generation of potentially lipotoxic acyl intermediates, leading to cardiac dysfunction. The mitochondrial long chain fatty acid transporter, CPT1b was reduced (50%), with no change in the lesser, co-expressed CPT1a isoform in WD hearts. Despite reduced CPT1b in WD hearts, contributions from LCFAs to acetyl CoA production in the citric acid cycle were unchanged, suggesting that the WD provided sufficient LCFAs for mitochondrial oxidation and that the reduced CPT1b was not limiting. In conclusion, western diet expands the TG pool but impairs fat storage dynamics via low ATGL, leading to early diastolic dysfunction and eventual systolic dysfunction. Nutrient overload from WD leads to impaired cardiac lipid dynamics with early diastolic dysfunction that is distinguished from HFpEF due to later systolic dysfunction.

scholarly journals Diastolic versus systolic dysfunction in patients with chronic liver disease – A single center study in South-South, Nigeria

2021 ◽  
Vol 5 ◽  
pp. 1-7
Author(s):  
Uchenna Njideofor ◽  
Uchenna Okonkwo ◽  
Victor O Ansa ◽  
Clement O Odigwe
Keyword(s):  
Liver Disease ◽  
Diastolic Dysfunction ◽  
Chronic Liver Disease ◽  
Left Atrial ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Chronic Liver ◽  
Cirrhotic Cardiomyopathy ◽  
Female Ratio

Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients.

scholarly journals A study to assess the echocardiographic changes among chronic liver disease in a tertiary care center

2019 ◽  
Vol 6 (6) ◽  
pp. 1740
Author(s):  
Aradya H. Venu ◽  
Col Muralidhar
Keyword(s):  
Liver Disease ◽  
Diastolic Dysfunction ◽  
Chronic Liver Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Chronic Liver ◽  
Tertiary Care Center ◽  
Cirrhotic Cardiomyopathy ◽  
Cardiac Abnormalities ◽  
Study Population

Background: Cirrhosis is associated with numerous cardiac abnormalities; however scanty information is available about the changes associated with it in Indian diaspora. which include increased cardiac output, left ventricular diastolic dysfunction, increased wall thickness of cardiac chambers, and pulmonary arterial hypertension. These concomitant cardiac abnormalities in patients with cirrhosis have been termed as ‘Cirrhotic Cardiomyopathy’. Objective of this study assess the Echocardiographic Changes among Chronic Liver disease in a tertiary care center. Method: Thirty patients with cirrhosis (alcoholic and non-alcoholic) were enrolled for the study at Department of Gastroenterology, Command Hospital, Air force, Bangalore from October 2007 to June 2009. Thirty age and sex matched controls without cardiovascular disease were included for comparison. Data collection was done by clinical history, examination and investigations. All subjects underwent Echocardiographic study was at 6 and 12 months and controls at the start of study.Results: Mean age of the study population was 54.5±15 yrs, males constituted 93% of the study population. Majority of the patients were in Child class B (43.3%) and Child A (40%). Interventricular septal thickness showed significant change compared to Control. There was no evidence of systolic dysfunction noted in the study population. There was no correlation between severity of cirrhosis and echocardiographic Changes.Conclusion: This study demonstrates that Indian patients with cirrhosis do have diastolic dysfunction. In the absence of other risk factors for cardiac disease, this dysfunction can be attributed only to cirrhotic cardiomyopathy. There is no correlation of cardiac status with severity of liver dysfunction.

scholarly journals Cirrhotic Cardiomyopathy

2021 ◽  
Vol 12 (1) ◽  
pp. 76-88
Author(s):  
Kieran Longley ◽  
Tuan Tran ◽  
Vincent Ho
Keyword(s):  
Heart Rate ◽  
Diastolic Dysfunction ◽  
Cardiac Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Cirrhotic Cardiomyopathy ◽  
Qt Interval Prolongation ◽  
Ventricular Diastolic Dysfunction

Cirrhotic cardiomyopathy (CCM), cardiac dysfunction in end-stage liver disease in the absence of prior heart disease, is an important clinical entity that contributes significantly to morbidity and mortality. The original definition for CCM, established in 2005 at the World Congress of Gastroenterology (WCG), was based upon known echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Subsequent advances in cardiovascular imaging and in particular myocardial deformation imaging have rendered the WCG criteria outdated. A number of investigations have explored other factors relevant to CCM, including serum markers, electrocardiography, and magnetic resonance imaging. CCM characteristics include a hyperdynamic circulatory state, impaired contractility, altered diastolic relaxation, and electrophysiological abnormalities, particularly QT interval prolongation. It is now known that cardiac dysfunction worsens with the progression of cirrhosis. Treatment for CCM has traditionally been limited to supportive efforts, but new pharmacological studies appear promising. Left ventricular diastolic dysfunction in CCM can be improved by targeted heart rate reduction. Ivabradine combined with carvedilol improves left ventricular diastolic dysfunction through targeted heart rate reduction, and this regimen can improve survival in patients with cirrhosis. Orthotopic liver transplantation also appears to improve CCM. Here, we canvass diagnostic challenges associated with CCM, introduce cardiac physiology principles and the application of echocardiographic techniques, and discuss the evidence behind therapeutic interventions in CCM.

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