Liver Abnormalities in Cardiac Diseases and Heart Failure

Abstract

Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a noncardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin. Impaired perfusion from decreased cardiac output may be associated with acute hepatocellular necrosis with marked elevations in serum aminotransferases. Cardiogenic ischemic hepatitis (''shock liver'') may ensue following an episode of profound hypotension in patients with acute HF. We discuss pathophysiology and identification of liver abnormalities that are commonly seen in patients with HF.

How to interpret liver function tests in heart failure patients?

“…In cardiac hepatopathy, the primary pathophysiology is either passive venous congestion that results in "congestive hepatopathy (CH)" or low cardiac output and arterial hypoperfusion that results in "acute cardiogenic liver injury (ACLI)" (14,15,17,18). In literature, ischemic hepatitis, shock liver, or hypoxic hepatopathy have also been used instead of ACLI, however, we propose that ACLI provides more details about the underlying pathophysiological process (18,19).…”

“…CH generally occurs in the setting of chronic cardiac conditions that may increase systemic venous pressure such as chronic HF, constrictive pericarditis, mitral stenosis, tricuspid regurgitation, cor pulmonale, severe pulmonary arterial hypertension, long-standing Fontan procedure, or right-sided HF of any cause. Acute cardiogenic liver injury, however, is most commonly associated with acute cardiocirculatory failure resulting from acute myocardial infarction, acute decompensated HF (ADHF), myocarditis, or massive pulmonary embolism (17,18). In fact, passive congestion secondary to right-sided HF and reduced arterial perfusion and oxygenation due to left-sided HF often coexist and potentiate the deleterious effects of each other on the liver (11,14,19,20).…”

“…Congestive hepatopathy is generally asymptomatic, but a mild discomfort in the right upper quadrant caused by liver cap-sule stretching, early satiety, nausea, and anorexia is reported by some patients (17,37). Jaundice, tender hepatomegaly, hepatojugular reflux, ascites, and pulsatile liver are the main findings on physical examination (17,38).…”

“…Jaundice, tender hepatomegaly, hepatojugular reflux, ascites, and pulsatile liver are the main findings on physical examination (17,38). In a retrospective analysis of 661 patients referred to a "jaundice hotline" service, a primary cardiac cause is identified in eight patients (1.2%) as an underlying cause for jaundice (39).…”

Liver Congestion in Heart Failure Contributes to Inappropriately Increased Serum Hepcidin despite Anemia

“…In this study, we tested the hypothesis in HF patients admitted to the Cardiovascular Disease Department of Niigata University Medical and Dental Hospital. In addition, pulmonary arterial hypertension (PAH) generally leads to right HF and sometimes cause to LC (Alvarez and Mukherjee 2011). It has been reported that inappropriately raised hepcidin levels may be a causative factor for FID of patients with PAH (Rhodes et al 2011), but the mechanisms of increased hepcidin levels in PAH are largely unknown.…”