Діагностика та лікування циротичної кардіоміопатії

Cirrhotic cardiomyopathy (CCM) refers to the structural and functional changes in the heart leading to systolic, diastolic, electrocardiographic, and neurohormonal disorders associated with liver cirrhosis and portal hypertension. It is characterized by impaired left ventricular systolic and diastolic dysfunction and electrophysiological abnormalities, especially QT interval prolongation. The disease usually remains asymptomatic with almost normal heart function, unless patients are exposed to stress or exertion. The proposed diagnostic criteria for CCM define it as documented echocardiographic findings of systolic or diastolic dysfunction (using conventional 2D‑echocardiogram), with or without electrophysiological abnormalities or elevated biomarkers in cirrhotic patients. Compared to 2D echocardiograms, tissue Doppler imaging has better sensitivity and specificity when evaluating cardiac dysfunction. Advances in cardiac imaging, such as cardiac magnetic resonance imaging and the incorporation of an exercise challenge, may help further refine the diagnosis of CCM. Optimum management remains unclear, and further study is needed in this area. Treatment for CCM has traditionally been limited to supportive efforts, but new pharmacological studies appear promising. Ivabradine combined with carvedilol improves left ventricular diastolic dysfunction through targeted heart rate reduction, and this regimen can improve survival of patients with cirrhosis. Orthotopic liver transplantation also appears to improve CCM. The constant development of novel diagnostic and clinical tools continuously delivers new data and findings about this broad disorder. This review discusses imaging techniques such as cardiac magnetic resonance imaging and scintigraphy, cardiac biomarkers, and newer echocardiographic techniques such as tissue Doppler imaging and speckle tracking, and emerging treatments to improve outcomes.