Cardiomiopatía cirrótica – ¿Realidad clínica o simple curiosidad académica? Revisión. : Parte 3: tratamiento

Hugo Ramos; Mario Altieri

doi:10.31053/1853.0605.v81.n3.44420

Authors

Hugo Ramos Facultad de Ciencias Médicas, Universidad Nacional de Córdoba. División Cardiología, Instituto Modelo de Cardiologia
Mario Altieri Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

DOI:

https://doi.org/10.31053/1853.0605.v81.n3.44420

Keywords:

liver cirrhosis, cardiomyopathy, treatment, liver transplantation

Abstract

Hepatic transplantation (HT) is the standard of care of end-stage liver disease with Cirrhotic Cardiomyopathy (CCM), but medical treatment with combination of diuretics and non-selective beta blockers are important before and after that. Owing to its particular pathophysiology unlike another etiologies of heart failure, in CCM angiotensin-converting enzyme inhibitors (ACEI), angiotensin II type I receptor blockers (ARB), and angiotensin receptor neprilysin inhibitor (ARNI) are not recommended. Transjugular intrahepatic porto-systemic shunt (TIPS) has indications in CMM but its potential benefits and risks must be considered and more researh is necessary. HT is a demanding therapy but the most effective one, and showed improvement in QTc, diastolic and systolic dysfunction; in recent decades, in spite of more severe ill patients (more severe MELD score), survival has improved significantly due to better surgical techniques, intensive care, immunosupresive drugs, and images.

Author Biographies

Hugo Ramos, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba. División Cardiología, Instituto Modelo de Cardiologia

Egresado de la Universidad Nacional de Córdoba. Especialista en Clínica Médica, Especialista en Cardiología (CMPC y UNC), Especialista en Medicina de Emergencias (CMPC). Doctor en Medicina y Cirugía FCM, UNC. Ex Jefe del Depto de Clínica Médica del Hospital Municipal de Urgencias de Córdoba, Cardiólogo en Instituto Modelo de Cardiología de Córdoba. Prof. Asociado en la Cátedra de Clínica Médica I, UHMI 2 del Hospital San Roque, FCM, UNC. Campo de investigación: biomarcadores cardíacos, insuficiencia cardíaca, cardiopatía isquémica. ORCID ID: https://orcid.org/0000-0001-6772-903X
Mario Altieri, Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

Egresado de la Universidad Nacional de Córdoba. Especialista en Medicina Interna y Terapia Intensiva (CMPC), Especialista en Terapia Intensiva (Francia). Ex Prof. de Medicina Intensiva de la Universidad Católica de Córdoba. Ex Director del programa Medicob de trasplante de Hígado, Caen, Francia. Miembro fundador del Cirrhotic Cardiomyopathy Consortium. Ex Miembro del Comité Ejecutivo de la International Liver Transplant Society (ILTS) para problemas cardiovasculares y cirrosis. ORCID ID: https://orcid.org/0000-0003-4164-1771.

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