In advanced stages of cirrhosis, structural, and functional cardiac abnormalities occur.
在肝硬化的晚期，会发生结构上和功能上的心脏异常。
This cirrhosis associated cardiomyopathy (CCM) leads to impaired contractile responsiveness to stress, diastolic dysfunction, myocardial hypertrophy, and electrophysiological abnormalities in the absence of other known cardiac disease[176,177].
这种肝硬化相关的心肌病(CCM)，如果没有其他已知的心肌疾病[176,177]，就会导致对应激的收缩反应性受损、舒张功能障碍、心肌肥厚和电生理异常。
Cirrhosis associated cardiomyopathy has been suggested as a key factor in the development of RA, hyponatremia, and HRS.
肝硬化相关的心肌病被认为是RA、低钠血症和HRS发展的关键因素。
As many as 50% of end-stage patients undergoing liver transplantation show signs of cardiac dysfunction[177-179].
多达50%的接受肝移植手术的终末期患者出现了心功能不全的迹象[177-179]。
Shunting of portal blood into the systemic circulation after TIPS leads to a sudden increase in cardiac preload and output that can rapidly worsen the hyperdynamic circulatory state in patients with cirrhosis.
TIPS后将门静脉血分流到体循环中，导致心脏预负荷和输出量的突然增加，可迅速加重肝硬化患者的高动力循环状态。
Cardiac complications noted post-TIPS commonly include clinically evident heart failure in those with RA.
TIPS术后发现的心脏并发症通常包括RA患者临床明显的心力衰竭。
Long-term cardiovascular changes, including cardiac volume overload and an increased rate of pulmonary hypertension, have also been reported[180].
长期的心血管变化，包括心脏容量过载和肺动脉高压发生率的增加，也有报道称[180]。
Initial prospective studies reported that the presence of diastolic dysfunction before TIPS was associated with post-procedural mortality within one year[178,181].
最初的前瞻性研究报道，TIPS前存在舒张功能障碍与一年内的术后死亡率相关。
However, these studies lacked an independent, blinded review of the echocardiography and relied solely on E/A (early maximal ventricular filling velocity/atrial maximal ventricular filling velocity) ratio < 1.to define diastolic dysfunction.
然而，这些研究缺乏对超声心动图的独立、盲法审查，且仅依赖于E/A（早期最大心室充盈速度/心房最大心室充盈速度）比率＜1来定义舒张期功能障碍。
Recent studies have found no relationship between diastolic dysfunction and post-TIPS survival or cardiac failure despite pre-TIPS rates of diastolic dysfunction ranging from 30%-45%[180,182,183].
最近的研究发现，尽管术前舒张功能障碍的发生率在30%-45%[180,182,183]之间，但舒张功能障碍与术后生存或心力衰竭之间没有关系。
Another study found that symptomatic heart failure was rare after TIPS (seen in < 1% of patients) and that this condition can be managed successfully when it is recognized early[184].
另一项研究发现，TIPS后有症状的心力衰竭非常罕见（见1%的患者），当发现早期[184]时，这种情况可以成功治疗。
However, a recent prospective study of 100 patients from France undergoing a complete cardiac evaluation before TIPS found that hospitalization for cardiac decompensation was observed in 20% of patients in the year after TIPS insertion[185].
然而，最近一项对来自法国的100名患者的前瞻性研究，在TIPS之前进行了完整的心脏评估，发现在TIPS术[185]后的一年中，20%的患者因心脏失代偿住院治疗。
The serum N-Terminal pro-B-type natriuretic peptide (NT-proBNP) was found to be predictive of cardiac decompensation after TIPS, but not mortality.
血清NT-proBNP被发现可以预测TIPS后的心脏失代偿，但不能预测死亡率。
The authors recommended that combining BNP or NT-proBNP levels and echocardiographic parameters should help improve patient selection.
作者建议结合BNP或NT-proBNP水平和超声心动图参数应有助于改善患者的选择。
BNP、NT-proBNP在心衰诊治中的作用主要： 第一，帮助明确心衰的诊断，但可影响它们的临床因素较多，所以二者特异性均不高，而有比较理想的阴性预测值，据文献报道，BNP、NT-proBNP不高都可以排除大约95%以上的心衰。 第二，指导心衰的治疗，因为二者半衰期都不长，所以在同一患者身上前后对比，可以较为理想的反映当下的心脏负荷。 第三，判断预后，BNP、NT-proBNP持续大幅度升高或经治疗后难以下降，往往提示不良预后。二者的局限在于不能鉴别收缩型心衰和舒张型心衰，因为无论哪种心衰，心室的压力都可升高，而引起BNP前体的降解和此二者的产生。在不同患者之间这两个数值升高的幅度与症状的轻重程度之间没有平行关系。
Recently left ventricular global longitudinal strain has been utilized to identify cirrhotic patients with underlying cardiac dysfunction[186].
最近左心室整体纵向应变被用于识别潜在心功能障碍[186]的肝硬化患者。
It was found that impaired cardiac contractility, reflected by higher left ventricular global longitudinal strain, predisposes to the development of acute-on-chronic liver failure and death in cirrhosis.
研究发现，左心室整体纵向应变升高反映的左心室心收缩力受损，易导致肝硬化中发生急性对慢性肝衰竭和死亡。
Current guidelines suggest a detailed cardiac history, physical examination, 12-lead electrocardiogram, echocardiography, and NT-proBNP in all patients undergoing elective TIPS placement with invasive cardiac assessment reserved for patients in whom the initial evaluation is abnormal[187].
目前的指南建议，所有接受选择性TIPS的患者都有详细的心脏病史、体格检查、12导联心电图、超声心动图和NT-proBNP，其中侵入性心脏评估保留给初始评估为[187]异常的患者。
Severe PAH-defined as mean pulmonary artery pressure (mPAP) > 45 mmHg-represents an absolute contraindication to TIPS.
严重肺动脉高压-定义为平均肺动脉压力(mPAP)和45mmHg，代表TIPS的绝对禁忌症。
In patients with moderate PAH (mPAP between 35-45 mmHg) with elevated pulmonary capillary wedge pressure (> 15 mmHg), TIPS can be placed in emergencies for established indications (like variceal bleeding refractory to endoscopic and pharmacologic treatment)[187].
对于中度PAH（mPAP在35-45mmH柱之间）和肺毛细血管楔形压（＞15mmH柱）升高的患者，TIPS可紧急放置，以确定适应症（如内镜和药物治疗难治的静脉曲张出血)[187]。
In patients with severe left ventricular dysfunction, elective TIPS is contraindicated.
对于严重左心室功能障碍的患者，选择性TIPS是禁忌症。
The cardiologic workup should also include contrast echocardiography aimed to demonstrate a patent foramen ovale, particularly in patients with PVT.
心脏检查还应包括对比超声心动图检查，以显示卵圆孔未闭，特别是对PVT患者。
Foramen ovale may serve as a conduit for paradoxical embolization, the occurrence of which has been reported following TIPS[188].
卵圆孔可作为矛盾栓塞的导管，已报道在TIPS[188]后发生。
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