The aim of review

gastro-j

Российский журнал гастроэнтерологии, гепатологии, колопроктологии

Russian Journal of Gastroenterology, Hepatology, Coloproctology

1382-43762658-6673

«Gastro» LLC

gastro-j-1521

Research Article

ЛЕКЦИИ И ОБЗОРЫ

LECTURES AND REVIEWS

Цирротическая кардиомиопатия

Cirrhotic cardiomyopathy

Маммаев

C. Н.

Mammayev

S. N.

Каримова

А. М.

Karimova

A. M.

Ильясова

Т. Э.

Il’yasova

T. E.

Хасаев

А. Ш.

Khasayev

A. Sh.

Дагестанская государственная медицинская академияRussian Federation

2010

30062010

2031928

2010

Маммаев C.Н., Каримова А.М., Ильясова Т.Э., Хасаев А.Ш.

Mammayev S.N., Karimova A.M., Il’yasova T.E., Khasayev A.S.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.gastro-j.ru/jour/article/view/1521

Цель обзора. Дать определение цирротической кардиомиопатии (ЦКМ), раскрыть ее патогенетические основы, особенности клинических проявлений, отразить основные терапевтические подходы, влияние ортотопической трансплантации печени (ОТП) и трансъюгулярного портосистемного шунтирования (TIPS) на течение и прогноз сердечно-сосудистых нарушений при циррозе печени (ЦП).Основные положения. Нарушение проведения сигнала с β-адренорецепторов, рецепторов кальциевых каналов, снижение текучести мембраны кардиомиоцитов, повышение синтеза оксида азота и монооксида углерода, активности эдоканнабиоидной системы и многие другие изменения, наблюдающиеся при ЦП, обусловливают развитие комплекса структурных и функциональных нарушений в миокарде, лежащих в основе формирования ЦКМ.Результаты многочисленных исследований продемонстрировали подавление сократительного ответа на действие различного вида физиологических и фармакологических стимулов, а также нарушение диастолической функции сердца, появление электрофизиологических, структурных и биохимических изменений при ЦП независимо от его генеза.Экспериментальные и клинические данные показали значительное улучшение сердечной деятельности после проведения ОТП, в то время как TIPS является своего рода стрессом для организма, способным привести к манифестации скрытых нарушений сердечной деятельности при ЦКМ. Низкий сердечный выброс при ЦКМ в условиях спонтанного бактериального перитонита также повышает риск развития гепаторенального синдрома (ГРС).Развитие декомпенсации сердечной недостаточности (СН) при воздействии провоцирующих факторов требует использования общепринятых терапевтических подходов к лечению таких больных. Однако существуют особенности ведения пациентов с ЦКМ: ограничение применения периферических вазодилататоров, бережное использование диуретиков, отсутствие существенного эффекта от β1-агонистов и предположительно положительное влияние β2-адреноблокаторов на QT-интервал, а также применение для снижения пред-и постнагрузки на сердце антагонистов альдостерона.Заключение. В проведенных исследованиях показаны основные клинические проявления ЦКМ, влияние на ее течение и прогноз различных фармакологических препаратов, установки TIPS и выполнения ОТП. Но необходимо проведение дальнейших крупных рандомизированных исследований, посвященных диагностике и лечению ЦКМ, с получением серьезной доказательной базы. Их целью должны явиться детальное изучение патогенетических механизмов, разработка четких общепринятых диагностических критериев и методов лечения этой категории больных.

The aim of review

The aim of review. To define cirrhotic cardiomyopathy (CCM), to reveal its pathogenic mechanisms, features of clinical manifestations, to reflect main therapeutic approaches, effect of orthotopic transplantation of liver (OTL) and transjugular portosystemic shunting (TIPS) on the course and prognosis of cardio-vascular disorders at liver cirrhosis (LC).

Original positions

Original positions. Disorder of signal conduction from β-adrenoreceptors, calcium channels receptors, decrease of cardiomyocyte membrane fluidity, increase of nitric oxide and carbon monoxide synthesis, elevation of endocannabinoid system activity and many other changes observed at LC, cause development of complex of structural and functional disorders in myocardium, underlying development of CCM. Results of numerous studies showed suppression of contractile response to action of various physiological and pharmacological stimuli, and disorder of diastolic function of the heart, development of electrophysiological, structural and biochemical changes at LC irrespective of its origin. Experimental and clinical data demonstrated significant improvement of cardiac activity after OTL, while TIPS acts as a kind of stress for the body, that is capable to manifest concealed disorders of cardiac activity at CCM. Low heart output at CCM in spontaneous bacterial peritonitis also increases risk of hepatorenal syndrome (HRS). Development of heart failure (HF) decompensation due to provoking factors action requires application of the standard therapeutic approaches to treatment of such patients. However there is specificity of CCM management: limited application of peripheral vasodilators, careful use of diuretics, absence of substantial effect of b1-agonists and presumably positive effect of b2-adrenoblockers on QT-interval and application of aldosterone antagonists to decrease both pre- and postload on the heart.

Conclusion

Conclusion. In studies, that were carried out, main clinical manifestations of CCM, effect on its course and the prognosis of various pharmacological drugs, application of TIPS and OTL were demonstrated. However, further large randomized investigations devoted to diagnostics and treatment of CCM, receiving serious evidential base are necessary. Their aim should be the detailed studying of pathogenic mechanisms, development of clear standard diagnostic criteria and methods of treatment of this category of patients.

цирротическая кардиомиопатиясистолическаядиастолическая дисфункция миокардаудлинение интервала QTтрансъюгулярное внутрипеченочное портосистемное шунтированиеортотопическая трансплантация печени

cirrhotic cardiomyopathysystolicdiastolic dysfunction of myocardiumelongation of QT intervaltransjugular intrahepatic portosystemic shuntingorthotopic transplantation of the liver

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The authors declare that there are no conflicts of interest present.