The Liver in Heart Failure: From Biomarkers to Clinical Risk

Abstract

Heart failure (HF) is a clinical syndrome due to heart dysfunction, but in which other organs are also involved, resulting in a complex multisystemic disease, burdened with high mortality and morbidity. This article focuses on the mutual relationship between the heart and liver in HF patients. Any cause of right heart failure can cause hepatic congestion, with important prognostic significance. We have analyzed the pathophysiology underlying this double interaction. Moreover, we have explored several biomarkers and non-invasive tests (i.e., liver stiffness measurement, LSM) potentially able to provide important support in the management of this complex disease. Cardiac biomarkers have been studied extensively in cardiology as a non-invasive diagnostic and monitoring tool for HF. However, their usefulness in assessing liver congestion in HF patients is still being researched. On the other hand, several prognostic scores based on liver biomarkers in patients with HF have been proposed in recent years, recognizing the important burden that liver involvement has in HF. We also discuss the usefulness of a liver stiffness measurement (LSM), which has been recently proposed as a reliable and non-invasive method for assessing liver congestion in HF patients, with therapeutic and prognostic intentions. Lastly, the relationship between LSM and biomarkers of liver congestion is not clearly defined; more research is necessary to establish the clinical value of biomarkers in assessing liver congestion in HF patients and their relationship with LSM.

Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study

“…This aspect further underlines the importance of redefining HF as a multisystemic syndrome rather than a simple heart disease, with pulmonary involvement and multisystemic end-organ damage severely impacting patient prognosis at each stage of disease [ 21 , 22 , 23 ]. The progressive risk of adverse outcomes according to increasing HLM severity stage sheds light on the importance of pathophysiology over clinical presentation in HF.…”

Evaluation of the relationship between estimated right atrial pressure and fibrosis-4 index in patients with congenital heart disease

“…Estimated RAP using the collapsibility index and maximum IVC diameter were used to categorize the patients into groups of increasing estimated RAP as defined by the 2019 American Society of Echocardiography guidelines 19,20 . If IVC diameter < 21mm and IVC collapsibility > 50%, the estimated right atrial pressure was evaluated as 3 mmHg (0-5), and if IVC diameter > 21 mm and IVC collapsibility < 50%, the estimated right atrial pressure was evaluated as 15 mmHg (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In other cases, the estimated right atrial pressure was evaluated as 8 mmHg [5][6][7][8][9][10]19,20 .…”

“…The fibrosis-4 index is expressed as a cheap, easy, and simple index to evaluate liver stiffness, and liver fibrosis [13][14][15] . The fibrosis-4 index consists of four parameters.…”

“…The fibrosis-4 index consists of four parameters. These parameters are aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelet count, and age [13][14][15] . Fibrosis-4 index formulated as = age (years) × AST (U/L)/[ALT (U/L)1/2 × platelet count (109/L)]( 14).…”

“…Fibrosis-4 index formulated as = age (years) × AST (U/L)/[ALT (U/L)1/2 × platelet count (109/L)]( 14). The fibrosis-4 index was stated to reflect liver stiffness/fibrosis associated with viral hepatitis of hepatitis C virus or human immunodeficiency virus infection and non-alcoholic fatty liver disease [13][14][15] . In studies conducted on patients with heart failure, it was found that fibrosis-4 index and all-cause mortality increased significantly as right atrial pressure and pro-brain natriuretic peptide increased [16][17][18] .…”