Cardiovascular Complications of Terminal Stage Cirrhosis and Related Clinical Significance_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Gang , REN Bo , XU Chen

Department of Anesthesiology, 302 Military Hospital of China, Beijing 100039, ChinaCorresponding Author: XU Chen, E-mail： xc0922@yahoo.com.cn;

Corresponding author：

Keywords：

Cirrhosis; Cardiovascular; Haemodynamic; Complication

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Objective　To introduce the clinical significance and pathophysiologic aspects of the circulatory and cardiac complications in terminal stage cirrhosis.
Methods　Recently relevant literatures were reviewed and summarized.
Results　Haemodynamic changes in cirrhosis arose on the basis of combined humoral and nervous dysregulation, with abnormalities in cardiovascular regulation, volume distribution and cardiac performance.
Conclusion　Comprehending the mechanisms of cardiovascular complications will contribute a lot for the treatment of terminal stage cirrhosis.

Citation： DONG Gang,REN Bo,XU Chen. Cardiovascular Complications of Terminal Stage Cirrhosis and Related Clinical Significance. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 411-412. doi: Copy

1.	Mller S, Henriksen JH. Cardiovascular complications of cirrhosis [J]. Postgrad Med J， 2009; 85(999): 44-54.
2.	叶乐驰, 张启瑜. 门静脉高压症内脏血管扩张机制的研究进展 [J]. 国际外科学杂志， 2006; 33(1)： 7-11.
3.	Henriksen JH, Mller S. Cardiac and systemic haemodynamic complications of liver cirrhosis [J]. Scand Cardiovasc J，2009; 43(4): 218-225.
4.	La Villa G, Gentilini P. Hemodynamic alterations in liver cirrhosis [J]. Mol Aspects Med, 2008; 29(1-2): 112-118.
5.	Large DA, Shah VH. Nitric oxide and portal hypertension: interface of vasoreactivity and angiogenesis [J]. J Hepatol, 2006; 44(1): 209-216.
6.	Dümcke CW, Mller S. Autonomic dysfunction in cirrhosis and portal hypertension [J]. Scand J Clin Lab Invest, 2008; 68(6): 437-447.
7.	Henriksen JH, Fuglsang S, Bendtsen F, et al. Arterial compliance in patients with cirrhosis： stroke volume-pulse pressure ratio as simplified index [J]. Am J Physiol, 2001; 280(4): G584-G594.
8.	Mller S, Henriksen JH. Cardiopulmonary complications in chronic liver disease [J]. World J Gastroenterol, 2006; 12(4): 526-538.
9.	Brinch K, Mller S, Bendtsen F, et al. Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease [J]. J Hepatol, 2003; 39(1): 24-31.
10.	Henriksen JH, Mller S, Schifter S, et al. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems [J]. Gut, 2001; 49(1): 112-118.
11.	Mller S, Hansen EF, Becker U, et al. Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients [J]. Liver, 2000; 20(1): 51-59.
12.	Gines P, Arroyo V, Rodes J, et al. Ascites and renal dysfunction in liver disease: Pathogenesis, Diagnosis, and Treatment [M]. 2nd Ed. Malden: Blackwell, 2005: 139-155.
13.	Ferlitsch A, plainer J, Mittermayer F, et al. Vasoconstrictor hyporeactivity can be reversed by antioxidants in patients with advanced alcoholic cirrhosis of the liver and ascites [J]. Crit Care Med, 2005; 33(9): 2028-2033.
14.	Lhuillier F, Dalmas ED, Gratadour PM, et al. Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation [J]. Eur J Anaesthesiol, 2006; 23(5): 426-432.
15.	Trevisani F, Sica G, Mainquà P, et al. Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites [J]. Hepatology, 1999; 30(6): 1387-1392.
16.	Laffi G, Barletta G, La Villa G, et al. Altered cardiovascular responsiveness to active tilting in nonalcoholic cirrhosis [J]. Gastroenterology, 1997; 113(3): 891-898.
17.	Grose RD, Nolan J, Dillon JF, et al. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis [J]. J Hepatol, 1995; 22(3): 326-332.
18.	Epstein SK, Ciubotaru RL, Zilberberg MD, et al. Analysis of impaired exercise capacity in patients with cirrhosis [J]. Dig Dis Sci, 1998; 43(8): 1701-1707.
19.	La Villa G, Barletta G, Romanelli RG, et al. Cardiovascular effects of canrenone in patients with preascitic cirrhosis [J]. Hepatology, 2002; 35(6): 1441-1448.
20.	Halliwill JR, Minson CT. Effect of hypoxia on arterial baroreflex control of heart rate and muscle sympathetic nerve activity in humans [J]. J Appl Physiol, 2002; 93(3): 857-864.
21.	Frith J, Newton JL. Autonomic dysfunction in chronic liver disease [J]. Liver Int, 2009; 29(4): 483-489.
22.	Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule [J]. Hepatology, 2006; 43(2 Suppl 1): S121-S131.
23.	Ginès P, Guevara M, De Las Heras D, et al. Review article: albumin for circulatory support in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2002; 16(Suppl 5): 24-31.
24.	Sola-Vera J, Miana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites [J]. Hepatology, 2003; 37(5): 1147-1153.
25.	Moreau R, Asselah T, Condat B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study [J]. Gut, 2002; 50(1): 90-94.
26.	Singh V, Kumar B, Nain CK, et al. Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study [J]. J Intern Med, 2006; 260(1): 62-68.
27.	Mller S, Sndergaard L, Mgelvang J, et al. Decreased right heart blood volume determined by magnetic resonance imaging: evidence of central underfilling in cirrhosis [J]. Hepatology, 1995; 22(2): 472-478.
28.	Baik SK, Fouad TR, Lee SS. Cirrhotic cardiomyopathy [J]. Orphanet J Rare Dis, 2007; 27: 2-15.
29.	Wong F. Cirrhotic cardiomyopathy [J]. Hepatol Int, 2009; 3(1): 294-304.
30.	Liu H, Gaskari SA, Lee SS. Cardiac and vascular changes in cirrhosis: pathogenic echanisms [J]. World J Gastroenterol, 2006; 12(6): 837-842.
31.	Wong F, Girgrah N, Graba J, et al. The cardiac response to exercise in cirrhosis [J]. Gut, 2001; 49(2): 268-275.
32.	Ginès P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis [J].Gastroenterology, 2002; 123(6): 1839-1847.
33.	Mller S, Dümcke CW, Krag A. The heart and the liver [J]. Expert Rev Gastroenterol Hepatol, 2009; 3(1): 51-64.
34.	Arroyo V, Fernandez J, Ginès P. Pathogenesis and treatment of hepatorenal syndrome [J]. Semin Liver Dis, 2008; 28(1): 81-95.
35.	Zambruni A, Trevisani F, Caraceni P, et al. Cardiac electrophysiological abnormalities in patients with cirrhosis [J]. J Hepatol, 2006; 44(5): 994-1002.
36.	陈峰松, 赵建妹. 肝硬变心肌病研究进展 [J]. 中国临床新医学, 2009; 2(1): 102-105.
37.	孙福荣, 王炳元. 肝硬化性心肌病 [J]. 胃肠病学和肝病学杂志, 2009; 18(4): 287-290.

1. Mller S, Henriksen JH. Cardiovascular complications of cirrhosis [J]. Postgrad Med J， 2009; 85(999): 44-54.
2. 　叶乐驰, 张启瑜. 门静脉高压症内脏血管扩张机制的研究进展 [J]. 国际外科学杂志， 2006; 33(1)： 7-11.
3. 　Henriksen JH, Mller S. Cardiac and systemic haemodynamic complications of liver cirrhosis [J]. Scand Cardiovasc J，2009; 43(4): 218-225.
4. 　La Villa G, Gentilini P. Hemodynamic alterations in liver cirrhosis [J]. Mol Aspects Med, 2008; 29(1-2): 112-118.
5. 　Large DA, Shah VH. Nitric oxide and portal hypertension: interface of vasoreactivity and angiogenesis [J]. J Hepatol, 2006; 44(1): 209-216.
6. 　Dümcke CW, Mller S. Autonomic dysfunction in cirrhosis and portal hypertension [J]. Scand J Clin Lab Invest, 2008; 68(6): 437-447.
7. 　Henriksen JH, Fuglsang S, Bendtsen F, et al. Arterial compliance in patients with cirrhosis： stroke volume-pulse pressure ratio as simplified index [J]. Am J Physiol, 2001; 280(4): G584-G594.
8. 　Mller S, Henriksen JH. Cardiopulmonary complications in chronic liver disease [J]. World J Gastroenterol, 2006; 12(4): 526-538.
9. 　Brinch K, Mller S, Bendtsen F, et al. Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease [J]. J Hepatol, 2003; 39(1): 24-31.
10. 　Henriksen JH, Mller S, Schifter S, et al. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems [J]. Gut, 2001; 49(1): 112-118.
11. 　Mller S, Hansen EF, Becker U, et al. Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients [J]. Liver, 2000; 20(1): 51-59.
12. 　Gines P, Arroyo V, Rodes J, et al. Ascites and renal dysfunction in liver disease: Pathogenesis, Diagnosis, and Treatment [M]. 2nd Ed. Malden: Blackwell, 2005: 139-155.
13. 　Ferlitsch A, plainer J, Mittermayer F, et al. Vasoconstrictor hyporeactivity can be reversed by antioxidants in patients with advanced alcoholic cirrhosis of the liver and ascites [J]. Crit Care Med, 2005; 33(9): 2028-2033.
14. 　Lhuillier F, Dalmas ED, Gratadour PM, et al. Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation [J]. Eur J Anaesthesiol, 2006; 23(5): 426-432.
15. 　Trevisani F, Sica G, Mainquà P, et al. Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites [J]. Hepatology, 1999; 30(6): 1387-1392.
16. 　Laffi G, Barletta G, La Villa G, et al. Altered cardiovascular responsiveness to active tilting in nonalcoholic cirrhosis [J]. Gastroenterology, 1997; 113(3): 891-898.
17. 　Grose RD, Nolan J, Dillon JF, et al. Exercise-induced left ventricular dysfunction in alcoholic and non-alcoholic cirrhosis [J]. J Hepatol, 1995; 22(3): 326-332.
18. 　Epstein SK, Ciubotaru RL, Zilberberg MD, et al. Analysis of impaired exercise capacity in patients with cirrhosis [J]. Dig Dis Sci, 1998; 43(8): 1701-1707.
19. 　La Villa G, Barletta G, Romanelli RG, et al. Cardiovascular effects of canrenone in patients with preascitic cirrhosis [J]. Hepatology, 2002; 35(6): 1441-1448.
20. 　Halliwill JR, Minson CT. Effect of hypoxia on arterial baroreflex control of heart rate and muscle sympathetic nerve activity in humans [J]. J Appl Physiol, 2002; 93(3): 857-864.
21. 　Frith J, Newton JL. Autonomic dysfunction in chronic liver disease [J]. Liver Int, 2009; 29(4): 483-489.
22. 　Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule [J]. Hepatology, 2006; 43(2 Suppl 1): S121-S131.
23. 　Ginès P, Guevara M, De Las Heras D, et al. Review article: albumin for circulatory support in patients with cirrhosis [J]. Aliment Pharmacol Ther, 2002; 16(Suppl 5): 24-31.
24. 　Sola-Vera J, Miana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites [J]. Hepatology, 2003; 37(5): 1147-1153.
25. 　 Moreau R, Asselah T, Condat B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study [J]. Gut, 2002; 50(1): 90-94.
26. 　Singh V, Kumar B, Nain CK, et al. Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study [J]. J Intern Med, 2006; 260(1): 62-68.
27. 　Mller S, Sndergaard L, Mgelvang J, et al. Decreased right heart blood volume determined by magnetic resonance imaging: evidence of central underfilling in cirrhosis [J]. Hepatology, 1995; 22(2): 472-478.
28. 　Baik SK, Fouad TR, Lee SS. Cirrhotic cardiomyopathy [J]. Orphanet J Rare Dis, 2007; 27: 2-15.
29. 　Wong F. Cirrhotic cardiomyopathy [J]. Hepatol Int, 2009; 3(1): 294-304.
30. 　Liu H, Gaskari SA, Lee SS. Cardiac and vascular changes in cirrhosis: pathogenic echanisms [J]. World J Gastroenterol, 2006; 12(6): 837-842.
31. 　Wong F, Girgrah N, Graba J, et al. The cardiac response to exercise in cirrhosis [J]. Gut, 2001; 49(2): 268-275.
32. 　Ginès P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis [J].Gastroenterology, 2002; 123(6): 1839-1847.
33. 　Mller S, Dümcke CW, Krag A. The heart and the liver [J]. Expert Rev Gastroenterol Hepatol, 2009; 3(1): 51-64.
34. 　Arroyo V, Fernandez J, Ginès P. Pathogenesis and treatment of hepatorenal syndrome [J]. Semin Liver Dis, 2008; 28(1): 81-95.
35. 　Zambruni A, Trevisani F, Caraceni P, et al. Cardiac electrophysiological abnormalities in patients with cirrhosis [J]. J Hepatol, 2006; 44(5): 994-1002.
36. 　陈峰松, 赵建妹. 肝硬变心肌病研究进展 [J]. 中国临床新医学, 2009; 2(1): 102-105.
37. 　孙福荣, 王炳元. 肝硬化性心肌病 [J]. 胃肠病学和肝病学杂志, 2009; 18(4): 287-290.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Cardiovascular Complications of Terminal Stage Cirrhosis and Related Clinical Significance

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