Діагностика та лікування циротичної кардіоміопатії

Автор(и)

DOI:

https://doi.org/10.30978/MG-2025-1-71

Ключові слова:

цироз печінки, кардіоміопатія, критерії діагностики, лікування, огляд

Анотація

Циротична кардіоміопатія (ЦКМ) належить до структурних і функціональних змін у серці, що призводять до систолічних, діастолічних, електрокардіографічних та нейрогормональних порушень, пов’яза­них із цирозом печінки та портальною гіпертензією. Вона характеризується систолічною та діастолічною дисфункцією лівого шлуночка та електрофізіологічними змінами, особливо подовженням інтервалу QT. Захворювання зазвичай перебігає безсимптомно з майже нормальною функцією серця, якщо пацієнти не піддаються стресу або навантаженню. Запропоновані діагностичні критерії визначають ЦКМ як задокументовані ехокардіографічні знахідки систолічної або діастолічної дисфункції (з використанням традиційної 2D‑ехокардіограми) з/без електрофізіологічних відхилень або підвищеного рівня біомаркерів у пацієнтів із цирозом печінки. Порівняно з 2D‑ехокардіограмою тканинна доплерівська візуалізація має кращу чутливість і специфічність при оцінці серцевої дисфункції. Досягнення у візуалізації серця, такі як магнітно‑резонансна томографія та використання фізичного навантаження, можуть допомогти уточнити діагноз ЦКМ. Специфічного лікування не існує, що потребує подальшого вивчення. Лікування ЦКМ традиційно обмежувалося підтримувальними зусиллями, але результати фармакологічних випробувань видаються багатообіцяючими. Івабрадин у поєднанні з карведілолом поліпшує діастолічну дисфункцію лівого шлуночка шляхом цілеспрямованого зниження частоти серцевих скорочень, що може поліпшити виживання пацієнтів із цирозом печінки. Ортотопічна трансплантація печінки також поліпшує ЦКМ. Удосконалення діагностичних і клінічних інструментів дають змогу отримати нові дані про це захворювання. В огляді висвітлено методи візуалізації, такі як магнітно‑резонансна томографія серця та сцинтиграфія, серцеві біомаркери та новітні ехокардіографічні методи, такі як тканинна доплерографія та спекл‑трекінг, а також нові методи лікування.

 

Біографії авторів

С. М. Чуклін, Медичний центр Святої Параскеви, Львів

д. мед. н., проф.

С. С. Чуклін, Медичний центр Святої Параскеви, Львів

лікар-хірург

А. Є. Євсютіна, Львівська обласна клінічна лікарня

лікар-хірург

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