肝硬化性心肌病病理生理学特点及治疗策略的研究进展
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摘要
肝硬化性心肌病(cirrhotic cardiomyopathy,CCM)是肝硬化常见的并发症之一。静息状态下该病较隐匿,无明显临床表现,应激状态下才能发展为显性心力衰竭,因而对其重视程度尚不够。应激状态下迟钝的心脏收缩反应、舒张功能不全、电生理异常(尤其是QTc间期延长)是该疾病的特征表现。该病发病机制不明,目前尚缺乏特异性的治疗措施。与非CCM导致的心力衰竭相比,药物治疗效果局限。原位肝移植作为终末期肝病的最终治疗选择,被证实可逆转CCM患者心脏功能异常,但应注重移植前心功能的评估。目前需要研究更加准确的诊断工具和制定有效的CCM治疗策略。因此,本文就CCM的病理生理特点及治疗策略的进展作一综述。
Cirrhotic cardiomyopathy(CCM)is one of the common complications of cirrhosis.Due to CCM remains asymptomatic in the resting state,it becomes overt heart failure only under stress,and has not be paid more attention.It is characterized by impaired contractile responsiveness to stress,altered diastolic relaxation,electrophysiological abnormalities(especially QTc interval prolongation).At present,the pathogenesis of CCM is unknown,and doesn't have specific treatment measures.Compared with heart failure caused by other diseases,drug treatment efficacy has limitations.Most of the studies have proved that orthotopic liver transplantation,as the eventual treatment for end-stage liver diseases,may reverse cardiac dysfunction.However,the cardiac function before transplantation should be evaluated.It is crucial to develop more accurate diagnostic tools and effective treatment strategies.This review discusses the advances in the pathophysiology and treatment strategies of CCM.
Cirrhotic cardiomyopathy(CCM)is one of the common complications of cirrhosis.Due to CCM remains asymptomatic in the resting state,it becomes overt heart failure only under stress,and has not be paid more attention.It is characterized by impaired contractile responsiveness to stress,altered diastolic relaxation,electrophysiological abnormalities(especially QTc interval prolongation).At present,the pathogenesis of CCM is unknown,and doesn't have specific treatment measures.Compared with heart failure caused by other diseases,drug treatment efficacy has limitations.Most of the studies have proved that orthotopic liver transplantation,as the eventual treatment for end-stage liver diseases,may reverse cardiac dysfunction.However,the cardiac function before transplantation should be evaluated.It is crucial to develop more accurate diagnostic tools and effective treatment strategies.This review discusses the advances in the pathophysiology and treatment strategies of CCM.
引文
[1]KOWALSKI H J,ABELMANN W H.The cardiac output at rest in Laennec’s cirrhosis[J].J Clin Invest,1953,32(10):1025-1033.
[2]MA Z,LEE S S.Cirrhotic cardiomyopathy:getting to the heart of the matter[J].Hepatology,1996,24(2):451-459.
[3]MLLER S,HENRIKSEN J H.Cirrhotic cardiomyopathy:apathophysiological review of circulatory dysfunction in liver disease[J].Heart,2002,87(1):9-15.
[4]MOLLER S,HENRIKSEN J H.Cardiovascular complications of cirrhosis[J].Gut,2008,57(2):268-278.
[5]TIMOH T,PROTANO M A,WAGMAN G,et al.A perspective on cirrhotic cardiomyopathy[J].Transplant Proc,2011,43(5):1649-1653.
[6]ZARDI E M,ABBATE A,ZARDI D M,et al.Cirrhotic cardiomyopathy[J].J Am Coll Cardiol,2010,56(7):539-549.
[7]MYERS R P,LEE S S.Cirrhotic cardiomyopathy and liver transplantation[J].Liver Transpl,2000,6(4 Suppl 1):S44-S52.
[8]BAIK S K,FOUAD T R,LEE S S.Cirrhotic cardiomyopathy[J].Orphanet J Rare Dis,2007,2:15.
[9]GOULD L,SHARIFF M,ZAHIR M,et al.Cardiac hemodynamics in alcoholic patients with chronic liver disease and a presystolic gallop[J].J Clin Invest,1969,48(5):860-868.
[10]WONG F,GIRGRAH N,GRABA J,et al.The cardiac response to exercise in cirrhosis[J].Gut,2001,49(2):268-275.
[11]MIKULIC E,MUOZ C,PUNTONI L E,et al.Hemodynamic effects of dobutamine in patients with alcoholic cirrhosis[J].Clin Pharmacol Ther,1983,34(1):56-59.
[12]KRAG A,BENDTSEN F,MORTENSEN C,et al.Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis[J].Eur J Gastroenterol Hepatol,2010,22(9):1085-1092.
[13]RUIZ-DEL-ARBOL L,URMAN J,FERNNDEZ J,et al.Systemic,renal,and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis[J].Hepatology,2003,38(5):1210-1218.
[14]RUIZ-DEL-ARBOL L,MONESCILLO A,AROCENA C,et al.Circulatory function and hepatorenal syndrome in cirrhosis[J].Hepatology,2005,42(2):439-447.
[15]MA Z,MIYAMOTO A,LEE S S.Role of altered betaadrenoceptor signal transduction in the pathogenesis of cirrhotic cardiomyopathy in rats[J].Gastroenterology,1996,110(4):1191-1198.
[16]GASKARI S A,LIU H,MOEZI L,et al.Role of endocannabinoids in the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats[J].Br J Pharmacol,2005,146(3):315-323.
[17]PACHER P,BTKAI S,KUNOS G.Cirrhotic cardiomyopathy:an endocannabinoid connection?[J].Br J Pharmacol,2005,146(3):313-314.
[18]YANG Y Y,LIU H,NAM S W,et al.Mechanisms of TNFalpha-induced cardiac dysfunction in cholestatic bile ductligated mice:interaction between TNFalpha and endocannabinoids[J].J Hepatol,2010,53(2):298-306.
[19]LEE R F,GLENN T K,LEE S S.Cardiac dysfunction in cirrhosis[J].Best Pract Res Clin Gastroenterol,2007,21(1):125-140.
[20]LIU H Q,MA Z H,LEE S S.Contribution of nitric oxide to the pathogenesis of cirrhotic cardiomyopathy in bile ductligated rats[J].Gastroenterology,2000,118(5):937-944.
[21]VAN OBBERGH L,VALLIERES Y,BLAISE G.Cardiac modifications occurring in the ascitic rat with biliary cirrhosis are nitric oxide related[J].J Hepatol,1996,24(6):747-752.
[22]LIU H,SONG D,LEE S S.Role of heme oxygenase-carbon monoxide pathway in pathogenesis of cirrhotic cardiomyopathy in the rat[J].Am J Physiol Gastrointest Liver Physiol,2001,280(1):G68-G74.
[23]WONG F.Cirrhotic cardiomyopathy[J].Hepatol Int,2009,3(1):294-304.
[24]CHEN X,ZHANG X,KUBO H,et al.Ca2+influx-induced sarcoplasmic reticulum Ca2+overload causes mitochondrialdependent apoptosis in ventricular myocytes[J].Circ Res,2005,97(10):1009-1017.
[25]ABBASI A,JOHARIMOQADDAM A,FARAMARZI N,et al.Opioid receptors blockade modulates apoptosis in a rat model of cirrhotic cardiomyopathy[J].Ann Med Health Sci Res,2014,4(3):404-409.
[26]NAGUEH S F,APPLETON C P,GILLEBERT T C,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography[J].Eur J Echocardiogr,2009,10(2):165-193..
[27]HUONKER M,SCHUMACHER Y O,OCHS A,et al.Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt[J].Gut,1999,44(5):743-748.
[28]KOVCS A,SCHEPKE M,HELLER J,et al.Short-term effects of transjugular intrahepatic shunt on cardiac function assessed by cardiac MRI:preliminary results[J].Cardiovasc Intervent Radiol,2010,33(2):290-296.
[29]SALERNO F,CAZZANIGA M,PAGNOZZI G,et al.Humoral and cardiac effects of TIPS in cirrhotic patients with different“effective”blood volume[J].Hepatology,38(6):1370-1377.
[30]CAZZANIGA M,SALERNO F,PAGNOZZI G,et al.Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt[J].Gut,2007,56(6):869-875.
[31]GLENN T K,HONAR H,LIU H,et al.Role of cardiac myofilament proteins titin and collagen in the pathogenesis of diastolic dysfunction in cirrhotic rats[J].J Hepatol,2011,55(6):1249-1255.
[32]TAKEDA Y,YONEDA T,DEMURA M,et al.Sodiuminduced cardiac aldosterone synthesis causes cardiac hypertrophy[J].Endocrinology,2000,141(5):1901-1904.
[33]KIM S,IWAO H.Molecular and cellular mechanisms of angiotensinⅡ-mediated cardiovascular and renal diseases[J].Pharmacol Rev,2000,52(1):11-34.
[34]KARAGIANNAKIS D S,VLACHOGIANNAKOS J,ANASTASIADIS G,et al.Frequency and severity of cirrhotic cardiomyopathy and its possible relationship with bacterial endotoxemia[J].Dig Dis Sci,2013,58(10):3029-3036.
[35]BERNARDI M,CALANDRA S,COLANTONI A,et al.QT interval prolongation in cirrhosis:prevalence,relationship with severity,and etiology of the disease and possible pathogenetic factors[J].Hepatology,1998,27(1):28-34.
[36]BAL J S,THULUVATH P J.Prolongation of QTc interval:relationship with etiology and severity of liver disease,mortality and liver transplantation[J].Liver Int,2003,23(4):243-248.
[37]MOHAMED R,FORSEY P R,DAVIES M K,et al.Effect of liver transplantation on QT interval prolongation and autonomic dysfunction in end-stage liver disease[J].Hepatology,1996,23(5):1128-1134.
[38]YTTING H,HENRIKSEN J H,FUGLSANG S,et al.Prolonged Q-T(c)interval in mild portal hypertensive cirrhosis[J].J Hepatol,2005,43(4):637-644.
[39]TREVISANI F,MERLI M,SAVELLI F,et al.QT interval in patients with non-cirrhotic portal hypertension and in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt[J].J Hepatol,2003,38(4):461-467.
[40]GENOVESI S,PRATA PIZZALA D M,POZZI M,et al.QT interval prolongation and decreased heart rate variability in cirrhotic patients:Relevance of hepatic venous pressure gradient and serum calcium[J].Clin Sci(Lond),2009,116(12):851-859.
[41]BERNARDI M,CALANDRA S,COLANTONI A,et al.QT interval prolongation in cirrhosis:Prevalence,relationship with severity,and etiology of the disease and possible pathogenetic factors[J].Hepatology,1998,27(1):28-34.
[42]ZAMBRUNI A,TREVISANI F,DI MICOLI A,et al.Effect of chronicβ-blockade on QT interval in patients with liver cirrhosis[J].J Hepatol,2008,48(3):415-421.
[43]BAL J S,THULUVATH P J.Prolongation of QTc interval:Relationship with etiology and severity of liver disease,mortality and liver transplantation[J].Liver Int,2003,23(4):243-248.
[44]CAREY E J,DOUGLAS D D.Effects of orthotopic liver transplantation on the corrected QT interval in patients with end-stage liver disease[J].Dig Dis Sci,2005,50(2):320-323.
[45]WONG F,SALERNO F.Beta-blockers in cirrhosis:friend and foe?[J].Hepatology,2010,52(3):811-813.
[46]TREVISANI F,DI MICOLI A,ZAMBRUNI A,et al.QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis[J].Liver Int,2012,32(10):1510-1515.
[47]BERNARDI M,RUBBOLI A,TREVISANI F,et al.Reduced cardiovascular responsiveness to exercise-induced sympathoadrenergic stimulation in patients with cirrhosis[J].J Hepatol,1991,12(2):207-216.
[48]LIMAS C J,GUIHA N H,LEKAGUL O,et al.Impaired left ventricular function in alcoholic cirrhosis with ascites.Ineffectiveness of ouabain[J].Circulation,1974,49(4):754-760.
[49]HENRIKSEN J H,BENDTSEN F,HANSEN E F,et al.Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval(QTc)in patients with cirrhosis[J].J Hepatol,2004,40(2):239-246.
[50]SERSTT,MELOT C,FRANCOZ C,et al.Deleterious effects of Beta-Blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology,2010,52(3):1017-1022.
[51]POZZI M,GRASSI G,RATTI L,et al.Cardiac,neuroadrenergic,and portal hemodynamic effects of prolonged aldosterone blockade in postviral child a cirrhosis[J].Am J Gastroenterol,2005,100(5):1110-1116.
[52]NAVASA M,FEU F,GARCA-PAGN J C,et al.Hemodynamic and humoral changes after livertransplantation in patients with cirrhosis[J].Hepatology,1993,17(3):355-360.
[53]GADANO A,HADENGUE A,WIDMANN J J,et al.Hemodynamics after orthotopic liver-transplantation-study of associated factors and long-term effects[J].Hepatology,1995,22(2):458-465.
[54]TORREGROSA M,AGUADS,DOS L,et al.Cardiac alterations in cirrhosis:reversibility after liver transplantation[J].J Hepatol,2005,42(1):68-74.
[55]ACOSTA F,DE LA MORENA G,VILLEGAS M,et al.Evaluation of cardiac function before and after liver transplantation[J].Transplant Proc,1999,31(6):2369-2370.
[56]FOUAD T R,ABDEL-RAZEK W M,BURAK K W,et al.Prediction of cardiac complications after liver transplantation[J].Transplantation,2009,87(5):763-770.
[57]SAMPAIO F,LAMATA P,BETTENCOURT N,et al.Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy[J].J Cardiovasc Magn Reson,2015,17:61.
[2]MA Z,LEE S S.Cirrhotic cardiomyopathy:getting to the heart of the matter[J].Hepatology,1996,24(2):451-459.
[3]MLLER S,HENRIKSEN J H.Cirrhotic cardiomyopathy:apathophysiological review of circulatory dysfunction in liver disease[J].Heart,2002,87(1):9-15.
[4]MOLLER S,HENRIKSEN J H.Cardiovascular complications of cirrhosis[J].Gut,2008,57(2):268-278.
[5]TIMOH T,PROTANO M A,WAGMAN G,et al.A perspective on cirrhotic cardiomyopathy[J].Transplant Proc,2011,43(5):1649-1653.
[6]ZARDI E M,ABBATE A,ZARDI D M,et al.Cirrhotic cardiomyopathy[J].J Am Coll Cardiol,2010,56(7):539-549.
[7]MYERS R P,LEE S S.Cirrhotic cardiomyopathy and liver transplantation[J].Liver Transpl,2000,6(4 Suppl 1):S44-S52.
[8]BAIK S K,FOUAD T R,LEE S S.Cirrhotic cardiomyopathy[J].Orphanet J Rare Dis,2007,2:15.
[9]GOULD L,SHARIFF M,ZAHIR M,et al.Cardiac hemodynamics in alcoholic patients with chronic liver disease and a presystolic gallop[J].J Clin Invest,1969,48(5):860-868.
[10]WONG F,GIRGRAH N,GRABA J,et al.The cardiac response to exercise in cirrhosis[J].Gut,2001,49(2):268-275.
[11]MIKULIC E,MUOZ C,PUNTONI L E,et al.Hemodynamic effects of dobutamine in patients with alcoholic cirrhosis[J].Clin Pharmacol Ther,1983,34(1):56-59.
[12]KRAG A,BENDTSEN F,MORTENSEN C,et al.Effects of a single terlipressin administration on cardiac function and perfusion in cirrhosis[J].Eur J Gastroenterol Hepatol,2010,22(9):1085-1092.
[13]RUIZ-DEL-ARBOL L,URMAN J,FERNNDEZ J,et al.Systemic,renal,and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis[J].Hepatology,2003,38(5):1210-1218.
[14]RUIZ-DEL-ARBOL L,MONESCILLO A,AROCENA C,et al.Circulatory function and hepatorenal syndrome in cirrhosis[J].Hepatology,2005,42(2):439-447.
[15]MA Z,MIYAMOTO A,LEE S S.Role of altered betaadrenoceptor signal transduction in the pathogenesis of cirrhotic cardiomyopathy in rats[J].Gastroenterology,1996,110(4):1191-1198.
[16]GASKARI S A,LIU H,MOEZI L,et al.Role of endocannabinoids in the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats[J].Br J Pharmacol,2005,146(3):315-323.
[17]PACHER P,BTKAI S,KUNOS G.Cirrhotic cardiomyopathy:an endocannabinoid connection?[J].Br J Pharmacol,2005,146(3):313-314.
[18]YANG Y Y,LIU H,NAM S W,et al.Mechanisms of TNFalpha-induced cardiac dysfunction in cholestatic bile ductligated mice:interaction between TNFalpha and endocannabinoids[J].J Hepatol,2010,53(2):298-306.
[19]LEE R F,GLENN T K,LEE S S.Cardiac dysfunction in cirrhosis[J].Best Pract Res Clin Gastroenterol,2007,21(1):125-140.
[20]LIU H Q,MA Z H,LEE S S.Contribution of nitric oxide to the pathogenesis of cirrhotic cardiomyopathy in bile ductligated rats[J].Gastroenterology,2000,118(5):937-944.
[21]VAN OBBERGH L,VALLIERES Y,BLAISE G.Cardiac modifications occurring in the ascitic rat with biliary cirrhosis are nitric oxide related[J].J Hepatol,1996,24(6):747-752.
[22]LIU H,SONG D,LEE S S.Role of heme oxygenase-carbon monoxide pathway in pathogenesis of cirrhotic cardiomyopathy in the rat[J].Am J Physiol Gastrointest Liver Physiol,2001,280(1):G68-G74.
[23]WONG F.Cirrhotic cardiomyopathy[J].Hepatol Int,2009,3(1):294-304.
[24]CHEN X,ZHANG X,KUBO H,et al.Ca2+influx-induced sarcoplasmic reticulum Ca2+overload causes mitochondrialdependent apoptosis in ventricular myocytes[J].Circ Res,2005,97(10):1009-1017.
[25]ABBASI A,JOHARIMOQADDAM A,FARAMARZI N,et al.Opioid receptors blockade modulates apoptosis in a rat model of cirrhotic cardiomyopathy[J].Ann Med Health Sci Res,2014,4(3):404-409.
[26]NAGUEH S F,APPLETON C P,GILLEBERT T C,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography[J].Eur J Echocardiogr,2009,10(2):165-193..
[27]HUONKER M,SCHUMACHER Y O,OCHS A,et al.Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt[J].Gut,1999,44(5):743-748.
[28]KOVCS A,SCHEPKE M,HELLER J,et al.Short-term effects of transjugular intrahepatic shunt on cardiac function assessed by cardiac MRI:preliminary results[J].Cardiovasc Intervent Radiol,2010,33(2):290-296.
[29]SALERNO F,CAZZANIGA M,PAGNOZZI G,et al.Humoral and cardiac effects of TIPS in cirrhotic patients with different“effective”blood volume[J].Hepatology,38(6):1370-1377.
[30]CAZZANIGA M,SALERNO F,PAGNOZZI G,et al.Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt[J].Gut,2007,56(6):869-875.
[31]GLENN T K,HONAR H,LIU H,et al.Role of cardiac myofilament proteins titin and collagen in the pathogenesis of diastolic dysfunction in cirrhotic rats[J].J Hepatol,2011,55(6):1249-1255.
[32]TAKEDA Y,YONEDA T,DEMURA M,et al.Sodiuminduced cardiac aldosterone synthesis causes cardiac hypertrophy[J].Endocrinology,2000,141(5):1901-1904.
[33]KIM S,IWAO H.Molecular and cellular mechanisms of angiotensinⅡ-mediated cardiovascular and renal diseases[J].Pharmacol Rev,2000,52(1):11-34.
[34]KARAGIANNAKIS D S,VLACHOGIANNAKOS J,ANASTASIADIS G,et al.Frequency and severity of cirrhotic cardiomyopathy and its possible relationship with bacterial endotoxemia[J].Dig Dis Sci,2013,58(10):3029-3036.
[35]BERNARDI M,CALANDRA S,COLANTONI A,et al.QT interval prolongation in cirrhosis:prevalence,relationship with severity,and etiology of the disease and possible pathogenetic factors[J].Hepatology,1998,27(1):28-34.
[36]BAL J S,THULUVATH P J.Prolongation of QTc interval:relationship with etiology and severity of liver disease,mortality and liver transplantation[J].Liver Int,2003,23(4):243-248.
[37]MOHAMED R,FORSEY P R,DAVIES M K,et al.Effect of liver transplantation on QT interval prolongation and autonomic dysfunction in end-stage liver disease[J].Hepatology,1996,23(5):1128-1134.
[38]YTTING H,HENRIKSEN J H,FUGLSANG S,et al.Prolonged Q-T(c)interval in mild portal hypertensive cirrhosis[J].J Hepatol,2005,43(4):637-644.
[39]TREVISANI F,MERLI M,SAVELLI F,et al.QT interval in patients with non-cirrhotic portal hypertension and in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt[J].J Hepatol,2003,38(4):461-467.
[40]GENOVESI S,PRATA PIZZALA D M,POZZI M,et al.QT interval prolongation and decreased heart rate variability in cirrhotic patients:Relevance of hepatic venous pressure gradient and serum calcium[J].Clin Sci(Lond),2009,116(12):851-859.
[41]BERNARDI M,CALANDRA S,COLANTONI A,et al.QT interval prolongation in cirrhosis:Prevalence,relationship with severity,and etiology of the disease and possible pathogenetic factors[J].Hepatology,1998,27(1):28-34.
[42]ZAMBRUNI A,TREVISANI F,DI MICOLI A,et al.Effect of chronicβ-blockade on QT interval in patients with liver cirrhosis[J].J Hepatol,2008,48(3):415-421.
[43]BAL J S,THULUVATH P J.Prolongation of QTc interval:Relationship with etiology and severity of liver disease,mortality and liver transplantation[J].Liver Int,2003,23(4):243-248.
[44]CAREY E J,DOUGLAS D D.Effects of orthotopic liver transplantation on the corrected QT interval in patients with end-stage liver disease[J].Dig Dis Sci,2005,50(2):320-323.
[45]WONG F,SALERNO F.Beta-blockers in cirrhosis:friend and foe?[J].Hepatology,2010,52(3):811-813.
[46]TREVISANI F,DI MICOLI A,ZAMBRUNI A,et al.QT interval prolongation by acute gastrointestinal bleeding in patients with cirrhosis[J].Liver Int,2012,32(10):1510-1515.
[47]BERNARDI M,RUBBOLI A,TREVISANI F,et al.Reduced cardiovascular responsiveness to exercise-induced sympathoadrenergic stimulation in patients with cirrhosis[J].J Hepatol,1991,12(2):207-216.
[48]LIMAS C J,GUIHA N H,LEKAGUL O,et al.Impaired left ventricular function in alcoholic cirrhosis with ascites.Ineffectiveness of ouabain[J].Circulation,1974,49(4):754-760.
[49]HENRIKSEN J H,BENDTSEN F,HANSEN E F,et al.Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval(QTc)in patients with cirrhosis[J].J Hepatol,2004,40(2):239-246.
[50]SERSTT,MELOT C,FRANCOZ C,et al.Deleterious effects of Beta-Blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology,2010,52(3):1017-1022.
[51]POZZI M,GRASSI G,RATTI L,et al.Cardiac,neuroadrenergic,and portal hemodynamic effects of prolonged aldosterone blockade in postviral child a cirrhosis[J].Am J Gastroenterol,2005,100(5):1110-1116.
[52]NAVASA M,FEU F,GARCA-PAGN J C,et al.Hemodynamic and humoral changes after livertransplantation in patients with cirrhosis[J].Hepatology,1993,17(3):355-360.
[53]GADANO A,HADENGUE A,WIDMANN J J,et al.Hemodynamics after orthotopic liver-transplantation-study of associated factors and long-term effects[J].Hepatology,1995,22(2):458-465.
[54]TORREGROSA M,AGUADS,DOS L,et al.Cardiac alterations in cirrhosis:reversibility after liver transplantation[J].J Hepatol,2005,42(1):68-74.
[55]ACOSTA F,DE LA MORENA G,VILLEGAS M,et al.Evaluation of cardiac function before and after liver transplantation[J].Transplant Proc,1999,31(6):2369-2370.
[56]FOUAD T R,ABDEL-RAZEK W M,BURAK K W,et al.Prediction of cardiac complications after liver transplantation[J].Transplantation,2009,87(5):763-770.
[57]SAMPAIO F,LAMATA P,BETTENCOURT N,et al.Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy[J].J Cardiovasc Magn Reson,2015,17:61.