Журнал «Медицина неотложных состояний» Том 21, №1, 2025

Цироз печінки є важливою причиною смертності, а доступ до трансплантації печінки значно поліпшив його прогноз. Проте більшість пацієнтів у листі очікування на трансплантацію печінки мають термінальну стадію захворювання печінки. Через помітну периферичну вазодилатацію термінальної стадії цирозу, яка маскує приховану дисфункцію міокарда, серцеві аномалії в стані спокою, як правило, є субклінічними, і лікарі не звертають на них уваги. Однак при стресі систолічна та діастолічна функції послаблюються. На додаток до цих аномалій скорочення, можуть спостерігатися морфологічні зміни, як-от збільшення або гіпертрофія серцевих камер, а також електрофізіологічні зміни реполяризації, включно з подовженням інтервалу QT. Сукупність цих серцевих аномалій називається циротичною кардіоміопатією. Трансплантація печінки викликає значний серцево-судинний стрес. Перетискання нижньої порожнистої та ворітної вен, кровотеча та інфузійна терапія, ішемія/реперфузія — все це спричиняє гемодинамічні коливання. Це збільшує робоче навантаження на серце, і, таким чином, раніше субклінічна дисфункція шлуночків може проявлятися у вигляді явної серцевої недостатності під час операційного та післяопераційного періодів. Однак, оскільки трансплантація печінки є єдиним остаточним методом лікування кінцевої стадії печінкової недостатності, а також, ймовірно, усуває кардіоміопатію, важливо розуміти зміни у серцево-судинній системі під час цієї операції. Хоча дані свідчать про те, що циротична кардіоміопатія може бути оборотною після ортотопічної трансплантації, потрібні подальші дослідження цього стану. Цей огляд присвячений фокусуванню на циротичній кардіоміопатії до, під час і після трансплантації печінки. У базах даних MedLine, Scopus було проведено пошук публікацій до 2024 року.

Liver cirrhosis is an important cause of mortality, and access to liver transplantation has significantly improved its prognosis. However, most patients in the liver transplant waiting list have end-stage liver disease. Due to the marked peripheral vasodilatation in end-stage cirrhosis that masks a latent myocardial dysfunction, cardiac abnormalities at rest are usually subclinical and escape the attention of physicians. However, when challenged, the systolic and diastolic functions are attenuated. In addition to these contractile abnormalities, morphological changes can be observed such as cardiac chamber enlargement or hypertrophy, and changes in electrophysiological repolarization, including a prolonged QT interval. A combination of these cardiac abnormalities is termed cirrhotic cardiomyopathy. Liver transplantation induces significant cardiovascular stress. Clamping of the inferior vena cava and portal vein, hemorrhage and infusion therapy, and ischemia/reperfusion all cause hemodynamic fluctuation. This increases the cardiac workload, and thus, subclinical ventricular dysfunction may manifest earlier as overt heart failure during surgery and in the postoperative period. However, because liver transplantation is the only definitive treatment for end-stage liver failure and also appears to reverse cardiomyopathy, it is important to understand the changes in the cardiovascular system during this intervention. Although evidence suggests that cirrhotic cardiomyopathy may be reversible after orthotopic liver transplantation, further investigation is needed. This review focuses on cirrhotic cardiomyopathy before, during, and after liver transplantation. MedLine, Scopus databases were searched for publications up to 2024.

цироз печінки; кардіоміопатія; трансплантація печінки; огляд

liver cirrhosis; cardiomyopathy; liver transplantation; review

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