Review Article: PDF OnlyCardiovascular Dysfunction in Patients with End-stage Liver DiseaseMandell, Merceds Susana; Tsou, Mei-Yungb, *Author Information aDepartment of Anesthesiology, University of Colorado Health Sciences Center, Aurora, Colorado, U.S.A. bDepartment of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C. *Correspondence to: Dr Mei-Yung Tsou, Department of Anesthesiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C E-mail: [email protected] Received: December 27, 2007; • Accepted: April 24, 2008. Journal of the Chinese Medical Association: July 2008 - Volume 71 - Issue 7 - p 331-335 doi: 10.1016/S1726-4901(08)70134-5 Metrics Abstract Most patients with advanced liver disease have a normal or even supernormal ejection fraction judged by echocardiogra-phy. Thus, physicians previously assumed that cardiac function was normal in most patients with liver disease. However, further investigation has uncovered multiple problems in cardiac performance that place patients at risk of heart failure. Patients with liver disease have defects in both systolic and diastolic function that only become obvious with physiologic stress such as liver transplantation. In addition there are additional defects in the electromechanical coupling of the heart that can have significant clinical consequences. These collective pathologic changes are termed “cirrhotic cardiomyopathy” and occur to some degree in all patients with liver disease. This review will explore the pathophysiology of cardiovascular changes in patients with end-stage liver disease. © 2008 by Lippincott Williams & Wilkins, Inc.