Skip to main content
Erschienen in: Wiener klinisches Magazin 4/2017

01.09.2017 | Intensivmedizin

Hepatokardiale Wechselwirkungen

Interaktionen zweier Organsysteme

verfasst von: Dr. Thomas Horvatits, Dr. Andreas Drolz, Dr. Karoline Rutter, Dr. Kevin Roedl, Prof. Dr. Stefan Kluge, Priv.-Doz. Dr. Valentin Fuhrmann

Erschienen in: Wiener klinisches Magazin | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Interaktionen zwischen dem kardialen und hepatalen System sind häufige Komplikationen bei Patienten mit Lebererkrankungen. Eine reduzierte kardiale Funktion ohne zugrunde liegende kardiale Erkrankung bei Patienten mit Leberzirrhose wird als zirrhotische Kardiomyopathie (CCMP) bezeichnet. Die typische hyperdyname Kreislaufregulation äußerst sich durch ein gesteigertes Herzzeitvolumen sowie einen herabgesetzten systemischen Gefäßwiderstand und kann so eine manifeste Herzinsuffizienz maskieren. Die portopulmonale Hypertension (POPH), eine Form der pulmonalarteriellen Hypertonie in Zusammenhang mit portaler Hypertension, ist eine seltene, doch schwerwiegende Komplikation bei Patienten mit chronischer Lebererkrankung. Als medikamentöse Therapieoption stehen Vasodilatoren, wie Prostazykline, Endothelinrezeptorantagonisten und Phosphodiesterase-5-Hemmer, zur Verfügung. Die hypoxische Hepatitis (HH) oder auch Schockleber geht mit einem fulminanten Transaminasenanstieg bedingt durch Leberzellnekrose infolge von kardialem, zirkulatorischem oder respiratorischem Versagen einher. Im folgenden Beitrag wird eine Übersicht über die genannten Krankheitsbilder gegeben.
Literatur
1.
Zurück zum Zitat Zardi EM, Abbate A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW et al (2010) Cirrhotic cardiomyopathy. J Am Coll Cardiol 56:539–549CrossRefPubMed Zardi EM, Abbate A, Zardi DM, Dobrina A, Margiotta D, Van Tassell BW et al (2010) Cirrhotic cardiomyopathy. J Am Coll Cardiol 56:539–549CrossRefPubMed
2.
3.
Zurück zum Zitat Wiese S, Hove JD, Bendtsen F, Moller S (2014) Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol 11:177–186CrossRefPubMed Wiese S, Hove JD, Bendtsen F, Moller S (2014) Cirrhotic cardiomyopathy: pathogenesis and clinical relevance. Nat Rev Gastroenterol Hepatol 11:177–186CrossRefPubMed
4.
Zurück zum Zitat Nazar A, Guevara M, Sitges M, Terra C, Sola E, Guigou C et al (2013) LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction. J Hepatol 58:51–57CrossRefPubMed Nazar A, Guevara M, Sitges M, Terra C, Sola E, Guigou C et al (2013) LEFT ventricular function assessed by echocardiography in cirrhosis: relationship to systemic hemodynamics and renal dysfunction. J Hepatol 58:51–57CrossRefPubMed
5.
Zurück zum Zitat Ortiz-Olvera NX, Castellanos-Pallares G, Gomez-Jimenez LM, Cabrera-Munoz ML, Mendez-Navarro J, Moran-Villota S et al (2011) Anatomical cardiac alterations in liver cirrhosis: an autopsy study. Ann Hepatol 10:321–326PubMed Ortiz-Olvera NX, Castellanos-Pallares G, Gomez-Jimenez LM, Cabrera-Munoz ML, Mendez-Navarro J, Moran-Villota S et al (2011) Anatomical cardiac alterations in liver cirrhosis: an autopsy study. Ann Hepatol 10:321–326PubMed
6.
8.
Zurück zum Zitat Ward CA, Liu H, Lee SS (2001) Altered cellular calcium regulatory systems in a rat model of cirrhotic cardiomyopathy. Gastroenterology 121:1209–1218CrossRefPubMed Ward CA, Liu H, Lee SS (2001) Altered cellular calcium regulatory systems in a rat model of cirrhotic cardiomyopathy. Gastroenterology 121:1209–1218CrossRefPubMed
9.
Zurück zum Zitat Bortoluzzi A, Ceolotto G, Gola E, Sticca A, Bova S, Morando F et al (2013) Positive cardiac inotropic effect of albumin infusion in rodents with cirrhosis and ascites: molecular mechanisms. Hepatology 57:266–276CrossRefPubMed Bortoluzzi A, Ceolotto G, Gola E, Sticca A, Bova S, Morando F et al (2013) Positive cardiac inotropic effect of albumin infusion in rodents with cirrhosis and ascites: molecular mechanisms. Hepatology 57:266–276CrossRefPubMed
10.
Zurück zum Zitat Ruiz-del-Arbol L, Achecar L, Serradilla R, Rodriguez-Gandia MA, Rivero M, Garrido E et al (2013) Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology 58:1732–1741CrossRefPubMed Ruiz-del-Arbol L, Achecar L, Serradilla R, Rodriguez-Gandia MA, Rivero M, Garrido E et al (2013) Diastolic dysfunction is a predictor of poor outcomes in patients with cirrhosis, portal hypertension, and a normal creatinine. Hepatology 58:1732–1741CrossRefPubMed
11.
Zurück zum Zitat Farr M, Schulze PC (2014) Recent advances in the diagnosis and management of cirrhosis-associated cardiomyopathy in liver transplant candidates: advanced echo imaging, cardiac biomarkers, and advanced heart failure therapies. Clin Med Insights Cardiol 8:67–74PubMed Farr M, Schulze PC (2014) Recent advances in the diagnosis and management of cirrhosis-associated cardiomyopathy in liver transplant candidates: advanced echo imaging, cardiac biomarkers, and advanced heart failure therapies. Clin Med Insights Cardiol 8:67–74PubMed
12.
Zurück zum Zitat Henriksen JH, Bendtsen F, Hansen EF, Moller S (2004) Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval (QTc) in patients with cirrhosis. J Hepatol 40:239–246CrossRefPubMed Henriksen JH, Bendtsen F, Hansen EF, Moller S (2004) Acute non-selective beta-adrenergic blockade reduces prolonged frequency-adjusted Q-T interval (QTc) in patients with cirrhosis. J Hepatol 40:239–246CrossRefPubMed
13.
Zurück zum Zitat Serste T, Melot C, Francoz C, Durand F, Rautou PE, Valla D et al (2010) Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 52:1017–1022CrossRefPubMed Serste T, Melot C, Francoz C, Durand F, Rautou PE, Valla D et al (2010) Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 52:1017–1022CrossRefPubMed
14.
Zurück zum Zitat Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M et al (2014) Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 146:1680–1690 e1681CrossRefPubMed Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M et al (2014) Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology 146:1680–1690 e1681CrossRefPubMed
15.
Zurück zum Zitat Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A et al (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62:D34–D41CrossRef Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A et al (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62:D34–D41CrossRef
16.
Zurück zum Zitat McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119:2250–2294CrossRefPubMed McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119:2250–2294CrossRefPubMed
17.
Zurück zum Zitat Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30:2493–2537CrossRefPubMed Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30:2493–2537CrossRefPubMed
18.
Zurück zum Zitat Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M et al (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42–D50CrossRef Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M et al (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42–D50CrossRef
19.
Zurück zum Zitat Peck-Radosavljevic M, Angermayr B, Datz C, Ferlitsch A, Ferlitsch M, Fuhrmann V et al (2013) Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II). Wien Klin Wochenschr 125:200–219CrossRefPubMed Peck-Radosavljevic M, Angermayr B, Datz C, Ferlitsch A, Ferlitsch M, Fuhrmann V et al (2013) Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II). Wien Klin Wochenschr 125:200–219CrossRefPubMed
20.
Zurück zum Zitat Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB (2004) Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 24:861–880CrossRefPubMed Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB (2004) Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 24:861–880CrossRefPubMed
21.
Zurück zum Zitat Horvatits T, Fuhrmann V (2014) Therapeutic options in pulmonary hepatic vascular diseases. Expert Rev Clin Pharmacol 7:31–42CrossRefPubMed Horvatits T, Fuhrmann V (2014) Therapeutic options in pulmonary hepatic vascular diseases. Expert Rev Clin Pharmacol 7:31–42CrossRefPubMed
23.
Zurück zum Zitat Horvatits T, Drolz A, Rutter K, Kluge S, Fuhrmann V (2014) [Pulmonary complications in liver diseases]. Med Klin Intensivmed Notfmed 109:235–239CrossRefPubMed Horvatits T, Drolz A, Rutter K, Kluge S, Fuhrmann V (2014) [Pulmonary complications in liver diseases]. Med Klin Intensivmed Notfmed 109:235–239CrossRefPubMed
24.
Zurück zum Zitat Swanson KL, Wiesner RH, Nyberg SL, Rosen CB, Krowka MJ (2008) Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 8:2445–2453CrossRefPubMed Swanson KL, Wiesner RH, Nyberg SL, Rosen CB, Krowka MJ (2008) Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 8:2445–2453CrossRefPubMed
25.
Zurück zum Zitat Le Pavec J, Souza R, Herve P, Lebrec D, Savale L, Tcherakian C et al (2008) Portopulmonary hypertension: survival and prognostic factors. Am J Respir Crit Care Med 178:637–643CrossRefPubMed Le Pavec J, Souza R, Herve P, Lebrec D, Savale L, Tcherakian C et al (2008) Portopulmonary hypertension: survival and prognostic factors. Am J Respir Crit Care Med 178:637–643CrossRefPubMed
26.
Zurück zum Zitat Goldberg DS, Batra S, Sahay S, Kawut SM, Fallon MB (2014) MELD exceptions for portopulmonary hypertension: current policy and future implementation. Am J Transplant 14:2081–2087CrossRefPubMedPubMedCentral Goldberg DS, Batra S, Sahay S, Kawut SM, Fallon MB (2014) MELD exceptions for portopulmonary hypertension: current policy and future implementation. Am J Transplant 14:2081–2087CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Faisal M, Siddiqi F, Alkaddour A, Bajwa AA, Shujaat A (2014) Effect of PAH specific therapy on pulmonary hemodynamics and six-minute walk distance in portopulmonary hypertension: a systematic review and meta-analysis. Pulm Med 2014:528783CrossRefPubMedPubMedCentral Faisal M, Siddiqi F, Alkaddour A, Bajwa AA, Shujaat A (2014) Effect of PAH specific therapy on pulmonary hemodynamics and six-minute walk distance in portopulmonary hypertension: a systematic review and meta-analysis. Pulm Med 2014:528783CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Henrion J, Minette P, Colin L, Schapira M, Delannoy A, Heller FR (1999) Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: a case-controlled, hemodynamic study of 17 consecutive cases. Hepatology 29:427–433CrossRefPubMed Henrion J, Minette P, Colin L, Schapira M, Delannoy A, Heller FR (1999) Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: a case-controlled, hemodynamic study of 17 consecutive cases. Hepatology 29:427–433CrossRefPubMed
29.
Zurück zum Zitat Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A et al (2009) Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients. Intensive Care Med 35:1397–1405CrossRefPubMed Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A et al (2009) Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients. Intensive Care Med 35:1397–1405CrossRefPubMed
30.
Zurück zum Zitat Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A et al (2011) Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 37:1302–1310CrossRefPubMed Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A et al (2011) Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 37:1302–1310CrossRefPubMed
31.
Zurück zum Zitat Drolz A, Horvatits T, Roedl K, Fuhrmann V (2014) [Shock liver and cholestatic liver in critically ill patients]. Med Klin Intensivmed Notfmed 109:228–234CrossRefPubMed Drolz A, Horvatits T, Roedl K, Fuhrmann V (2014) [Shock liver and cholestatic liver in critically ill patients]. Med Klin Intensivmed Notfmed 109:228–234CrossRefPubMed
32.
Zurück zum Zitat Jager B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M et al (2012) Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis. Hepatology 56:2297–2304CrossRefPubMed Jager B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M et al (2012) Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis. Hepatology 56:2297–2304CrossRefPubMed
33.
Zurück zum Zitat Drolz A, Jager B, Wewalka M, Saxa R, Horvatits T, Roedl K et al (2013) Clinical impact of arterial ammonia levels in ICU patients with different liver diseases. Intensive Care Med 39:1227–1237CrossRefPubMed Drolz A, Jager B, Wewalka M, Saxa R, Horvatits T, Roedl K et al (2013) Clinical impact of arterial ammonia levels in ICU patients with different liver diseases. Intensive Care Med 39:1227–1237CrossRefPubMed
34.
Zurück zum Zitat Fuhrmann V, Madl C, Mueller C, Holzinger U, Kitzberger R, Funk GC et al (2006) Hepatopulmonary syndrome in patients with hypoxic hepatitis. Gastroenterology 131:69–75CrossRefPubMed Fuhrmann V, Madl C, Mueller C, Holzinger U, Kitzberger R, Funk GC et al (2006) Hepatopulmonary syndrome in patients with hypoxic hepatitis. Gastroenterology 131:69–75CrossRefPubMed
35.
Zurück zum Zitat Horvatits T, Trauner M, Fuhrmann V (2013) Hypoxic liver injury and cholestasis in critically ill patients. Curr Opin Crit Care 19:128–132CrossRefPubMed Horvatits T, Trauner M, Fuhrmann V (2013) Hypoxic liver injury and cholestasis in critically ill patients. Curr Opin Crit Care 19:128–132CrossRefPubMed
36.
Zurück zum Zitat Drolz A, Horvatits T, Michl B, Roedl K, Schellongowski P, Holzinger U et al (2014) Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients. J Hepatol 60:1187–1193CrossRefPubMed Drolz A, Horvatits T, Michl B, Roedl K, Schellongowski P, Holzinger U et al (2014) Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients. J Hepatol 60:1187–1193CrossRefPubMed
Metadaten
Titel
Hepatokardiale Wechselwirkungen
Interaktionen zweier Organsysteme
verfasst von
Dr. Thomas Horvatits
Dr. Andreas Drolz
Dr. Karoline Rutter
Dr. Kevin Roedl
Prof. Dr. Stefan Kluge
Priv.-Doz. Dr. Valentin Fuhrmann
Publikationsdatum
01.09.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 4/2017
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-017-0183-0

Weitere Artikel der Ausgabe 4/2017

Wiener klinisches Magazin 4/2017 Zur Ausgabe

Panorama

Panorama