Abstract
Liver cirrhosis is a significant cause of morbidity and mortality and can result in
alterations to cardiac function. Patients with cirrhosis may develop a hyperdynamic
circulation. Furthermore, systolic or diastolic function may occur, although diastolic
function is more common. The transjugular intraheptic portosystemic shunt (TIPS) is
an increasingly prominent procedure to treat portal hypertension that can result in
transient worsening of hyperdynamic circulation. TIPS can be complicated by cardiac
decompensation, with diastolic dysfunction playing a key role. Investigators developed
an algorithm to stratify risk of cardiac decompensation after TIPS using natriuretic
peptide levels and echocardiography. Eighty percent of patients with aortic stenosis
decompensated after TIPS in one cohort, but this requires further study before it
is considered a contraindication. Cirrhosis has also been linked to development of
atrial fibrillation, although data remain mixed. The first-choice anticoagulant should
be direct oral anticoagulants, as studies show superior outcomes to warfarin. QTc
prolongation is often seen in patients with cirrhosis, theoretically predisposing
to ventricular arrhythmias, however the clinical significance remains unclear. The
impact of TIPS on arrhythmia is understudied, but small cohorts found high rates.
Overall, cirrhosis can have significant impacts of cardiac function and clinicians
must be aware of these alterations.
Keywords
cirrhosis - arrhythmia - TIPS - cirrhotic cardiomyopathy - hemodynamics
