What are your diagnostic and treatment goals for a patient with cirrhotic cardiomyopathy?

Cirrhotic cardiomyopathy (CCM) affects almost a third of liver transplant candidates. In the absence of primary cardiac disease abnormalities, diagnosis is based on echocardiographic criteria that predict pre-transplant morbidity and mortality, may be reversible, but abnormalities may persist even a year post liver transplant (higher risk patients with MASH cirrhosis). These patients suffer from high MACE, heart failure, arrhythmias, and cardiovascular mortality post-transplant. The echocardiographic criteria include abnormal longitudinal strain (GLS <18%), E/e' ratio or septal e" reflecting impaired relaxation, abnormal LAVI, and reduced EF (<50%). Electrocardiographic abnormalities include QT prolongation. Another parameter is blunted car...

Cirrhotic cardiomyopathy is a form of Cirrhotic disease that progresses to involve the heart, so diagnostic goals focus on detecting blunted contractile response, diastolic dysfunction, and electrophysiologic abnormalities (e.g., prolonged QT), while treatment is largely supportive and guided by standard heart failure principles, avoiding volume overload and managing complications of splanchnic congestion and liver fibrosis. Treating the underlying cirrhosis—especially with liver transplantation—can significantly improve or even reverse cardiac dysfunction over time, although recovery is variable and not always complete. Treatment goals focus on symptom management from volume control. If this is not achievable and there is progressive right...