Cirrhotic Cardiomyopathy Following Bile Duct Ligation in Rats-A Matter of Time?

Cirrhotic patients often suffer from cirrhotic cardiomyopathy (CCM). Previous animal models of CCM were inconsistent concerning the time and mechanism of injury; thus, the temporal dynamics and cardiac vulnerability were studied in more detail. Rats underwent bile duct ligation (BDL) and a second surgery 28 days later. Cardiac function was assessed by conductance catheter and echocardiography. Histology, gene expression, and serum parameters were analyzed. A chronotropic incompetence (P < 0.001) and impaired contractility at rest and a reduced contractile reserve (P = 0.03, P < 0.001) were seen 31 days after BDL with increased creatine (P, P, and P < 0.05) and transaminases (P < 0.001). A total of 56 days after BDL, myocardial fibrosis was seen (P < 0.001) accompanied by macrophage infiltration (CD68: P < 0.001) and systemic inflammation (TNFα: P < 0.001, white blood cell count: P < 0.001). Myocardial expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) was increased after 31 (P < 0.001) and decreased after 42 (P < 0.001) and 56 days (P < 0.001). Caspase-3 expression was increased 31 and 56 days after BDL (P = 0.005; P = 0.005). Structural changes in the myocardium were seen after 8 weeks. After the second surgery (second hit), transient myocardial insufficiency with secondary organ dysfunction was seen, characterized by reduced contractility and contractile reserve.