Lviv clinical bulletin 2020, 3(31): 8-18

Syntropic Lesions of the Cardiovascular System in Patients With Liver Cirrhosis: Their Determination; Selected Pathogenetic Mechanisms; Characteristics and Specifics; Clinical Markers, Their Prognostic Value; Justification and Effectiveness of Modified Treatment (First Notice)

M. Farmaha, M. Abrahamovych, O. Abrahamovych

Danylo Halytsky Lviv National Medical University

Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis, although often fatal, are poorly studied.

The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with liver cirrhosis, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment.

Materials and methods. We processed medical records of 603 patients with liver cirrhosis and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy, and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of liver cirrhosis. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with liver cirrhosis and syntropic cardiovascular lesions as well as to assess its effectiveness.

Results. At the first step of the study, we found that 81.26 % of patients with liver cirrhosis had circulatory system lesions, in particular, secondary cirrhotic cardiomyopathy (57.50 % of patients with the circulatory system lesions) and persistent arterial hypotension (35.31 % of patients with the circulatory system lesions) as syntropic lesions. At the second step, we found that patients with liver cirrhosis and syntropic lesions of the circulatory system had also autonomic dysfunction and endothelial dysfunction. At the third step, we detected left ventricular remodeling in patients with liver cirrhosis and syntropic secondary cirrhotic cardiomyopathy, along with diastolic dysfunction and elevated S. Tei-index scores; these indicators worsened in parallel with the increase in the severity of cirrhosis; S. Tei-index scores should be used to classify secondary cirrhotic cardiomyopathy by severity. Patients with liver cirrhosis and syntropic persistent arterial hypotension had reduced ratio between blood pressures during the day and at night, low variability in blood pressure; in parallel with the increase in the severity of cirrhosis, arterial hypotension progressed with a disturbed circadian rhythm and pressure variability at all stages of the disease; the indicator of average daily arterial pressure should be used to classify arterial hypotension by severity.

Conclusions. 81.26 % of patients with liver cirrhosis had comorbid lesions of the circulatory system, including secondary cirrhotic cardiomyopathy (57.50 %) and persistent arterial hypotension (35.31 %) as syntropic lesions; the activation of humoral and metabolic factors with disorders of the autonomic nervous system is one of the links in the pathogenesis of these syntropic lesions; syntropic secondary cirrhotic cardiomyopathy and persistent arterial hypotension have their specific characteristics, their manifestations worsen in parallel with the decompensation of liver cirrhosis, it is proposed to classify both diseases by severity.


  1. Abrahamovich OO, Abrahamovich MO, Farmaga ML, Tolopko SYa. Characteristics of syntropic polymorbid lesions in patients with liver cirrhosis and the dependence of their frequency on the severity of the disease. Modern Gastroenterology. Modern Gastroenterology. Contemporary Gastroenterology. 2013;4:23-30. (Ukrainian)
  2. Bokeria LA, Golukhova EZ, Ivanitsky AV. Functional diagnostics in cardiology. M.: NTSSSH imeni AN Bakuleva; 2005. 312 p. (Russian)
  3. Kovalenko CO, Kudiy LI. Heart rate variability. Methodological aspects. Cherkasy: Cherkasy. nat. B. Khmelnytsky University; 2016. 298 p. (Ukrainian)
  4. Courses SV, Mikhnevich KG, Lizogub NV, Skoroplet SN. Hepatopulmonary syndrome. Emergency Medicine. 2009;24:75-82. (Russian)
  5. Rybakova MK, Mitkov VV, Platova ML. Complex echocardiographic assessment of the systolic and diastolic function of the left and right ventricles is normal. Ultrasound and Functional Diagnostics. 2005;4:64-71. (Russian)
  6. Sergien OV, Panina SS, Voitchak TG et al. Epidemiological aspects and causes of disability due to chronic hepatitis. Gastroenterology. 2007;38:26-32. (Ukrainian)
  7. Sirenko UM, Radchenko GD, Granich VM, Reiko MM, Perekrestov VY, Polishchuk SA et al. The value of daily blood pressure monitoring for the diagnosis and treatment of hypertension: a method. recommendations. Kyiv: Institute of Cardiology, Academy of Medical Sciences of Ukraine; 2001. 32 p. (Ukrainian)
  8. Filippov YuO, Skirda IU, Petrechuk LM. Incidence of major diseases of the digestive system in Ukraine: an analytical review of official data of the Center for Statistics of the Ministry of Health of Ukraine. Gastroenterology. 2007;38:3-15. (Ukrainian)
  9. Yabluchanskiy NI, Martynenko AV. Heart rate variability to aid the practitioner. For real doctors. Kharkiv; 2010.131 p. (Russian)
  10. Abrahamovych O, Abrahamovych M, Farmaha M, Tolopko S. The peculiarities of the state of the autonomic nervous system estimated by the method of heart rate variability in patients with cirrhosis and syntropic damages of cardiovascular system. Georgian Med News. 2017;(273):23-30.
  11. Bolognesi M, Di Pascoli M, Verardo A, Gatta A. Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis. World J Gastroenterol. 2014;20(10):2555-2563.
  12. Busk TM, Bendtsen F, Poulsen JH et al. Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;314(2):G275-G286.
  13. Di Pascoli M, Sacerdoti D, Pontisso P, Angeli P, Bolognesi M. Molecular Mechanisms Leading to Splanchnic Vasodilation in Liver Cirrhosis. J Vasc Res. 2017;54(2):92-99.
  14. Gassanov N, Caglayan E, Semmo N, Massenkeil G, Er F. Cirrhotic cardiomyopathy: a cardiologist’s perspective. World J Gastroenterol. 2014;20(42):15492-1549
  15. Iwakiri Y, Kim MY. Nitric oxide in liver diseases. Trends Pharmacol Sci. 2015;36(8):524-536.
  16. Iwakiri Y. Nitric oxide in liver fibrosis: The role of inducible nitric oxide synthase. Clin Mol Hepatol. 2015;21(4):319-325.
  17. Marchetta S, Delwaide J, Lancellotti R. Cirrhotic cardiomyopathy: a brief overview. Rev Med Liege. 2015;70(2):86-91.
  18. McConnell M, Iwakiri Y. Biology of portal hypertension. Hepatol Int. 2018;12(Suppl 1):11-23.
  19. Miсano C, Garcia-Tsao G. Portal Hypertension. Gastroenterol Clin North Amer. 2010;39(3):681-695.
  20. Patel S, Rauf A, Khan H, Abu-Izneid T. Renin-angiotensin-aldosterone (RAAS): The ubiquitous system for homeostasis and pathologies. Biomed Pharmacother. 2017;94:317-325.
  21. Ruiz-del-Árbol L, Serradilla R. Cirrhotic cardiomyopathy. World J Gastroenterol. 2015;21(41):11502-11521.