Liver in heart failure

Czech version

Authors: Eva Goncalvesová
Authors‘ workplace: Oddelenie Zlyhávania a transplantácie srdca, prednostka doc. MUDr. Eva Goncalvesová, CSc., FESC, Národného ústavu srdcových a cievnych chorôb, Bratislava, Slovenská republika, generálny riaditieľ ing. Mongi Msolly, MBA
Published in: Vnitř Lék 2014; 60(4): 298-303
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Heart failure (HF) is a syndrome with multiple organ manifestations. Liver is due to its high metabolic activity and the resulting demands on oxygenation and also due to its anatomical position close to the heart damaged by heart failure very often. Despite the signs of liver damage are common in heart failure, clinically significant impairment of liver function rarely occurs. Liver lesion is caused by impaired hepatic circulation in terms of congestion and/or hypoperfusion. Congestive lesion is more common. Typically manifests as painful hepatomegaly, increased direct bilirubin and alkaline phosphatase. Pure ischemic lesion is rare. It occurs in a cases with severe and prolonged liver hypoperfusion often in combination with hypoxemia and results to the sharp rise of total bilirubin and transaminase levels. Short-term prognosis of this disorder, unless the cause hypoperfusion treated successfully, is poor. Increase in bilirubin and transaminase tests as well as signs of impaired proteosynthetic liver function are associated with poor prognosis. The worst prognosis have patients with HF and current primary liver disease. Knowledge phenotypes hepatic lesions in HF is important in choosing the tactics of treatment of acute HF decompensation.

Key words:
heart failure – liver – congestion – hypoperfusion

Sources

1. Jolliffe N. Liver Function in Congestive Heart Failure. J Clin Invest 1930; 8(3): 419–33.

2. Ambrosy AP, Vaduganathan M, Huffman MD et al. Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 2012; 14(3): 302–311.

3. Poelzl G, Ess M, Mussner-Seeber C et al. Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Invest 2012; 42(2): 153–163.

4. Nikolaou M, Parissis J, Yilmaz MB et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 2013; 34(10): 742–749.

5. Allen LA, Felker GM, Pocock S et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail 2009; 11(2): 170–177.

6. Dooley JS , Burroughs AK, Heathcote EJ. Sherlock´s Diseases of the Liver and Biliary System. Wiley-Blackwell: Oxford 2011. 12th Edition. ISBN 9781405134897.

7. Rappaport AM. Hepatic blood flow: morphologic aspects and physiologic regulation. Int Rev Physiol 1980; 21: 1–63.

8. Verbrugge FH, Dupont M, Steels P et al. Abdominal contributions to cardiorenal dysfunction in congestive heart failure. J Am Coll Cardiol 2013; 62(6): 485–495.

9. Sherlock S. The liver in heart failure; relation of anatomical, functional, and circulatory changes. Br Heart J 1951; 13(3): 273–293.

10. Hopper I, Kemp W, Porapakkham P et al. Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography. Eur J Heart Fail 2012; 14(6): 621–627.

11. Alegre F, Herrero JI, Inarrairaegui M et al. Increased liver stiffness values in patients with heart failure. Acta Gastroenterol Belg 2013; 76(2): 246–250.

12. Valentová M, von Haehling S, Doehner W et al. Liver dysfunction and its nutritional implications in heart failure. Nutrition 2013; 29(2): 370–378.

13. Hollander SA, Addonizio LJ, Chin C et al. Abdominal complaints as a common first presentation of heart failure in adolescents with dilated cardiomyopathy. Am J Emerg Med 2013; 31(4): 684–686.

14. Huffman JL, Schenker S Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 2010; 8(1): 15–22.

15. Goncalvesova E, Lesny P, Luknar M et al. Changes of portal flow in heart failure patients with liver congestion. Bratisl Lek Listy 2010; 111(12): 635–639.

16. Auer J. What does the liver tell us about the failing heart? Eur Heart J 2013; 34(10): 711–714.

17. Cogger VC, Fraser R, Le Couteur DG. Liver dysfunction and heart failure. Am J Cardiol 2003; 91(11): 1399.

18. Alvarez AM, Mukherjee D. Liver abnormalities in cardiac diseases and heart failure. Int J Angiol 2011; 20(3): 135–142.

19. Saner FH, Heuer M, Meyer M et al. When the heart kills the liver: acute liver failure in congestive heart failure. Eur J Med Res 2009; 14: 541–546.

20. van Deursen VM, Damman K, Hillege HL et al. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 2010; 16: 84–90.

21. Samsky MD, Patel CB, DeWald TA et al. Cardiohepatic interactions in heart failure: an overview and clinical implications. J Am Coll Cardiol 2013; 61(24): 2397–2405.

22. Matthews JC, Pagani FD, Haft JW et al. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 2010; 121(2): 214–220.

23. Yang JA, Kato TS, Shulman BP et al. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant 2012; 31(6): 601–610.

24. Lee DS, Austin PC, Rouleau JL et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003; 290(19): 2581–2587.

25. Bernardi M. Cirrhotic cardiomyopathy. Clinical Liver Disease 2013; 2(3): 99–101.

26. Zardi EM, Abbate A, Zardi DM et al. Cirrhotic Cardiomyopathy. J Am Coll Cardiol 2010; 56(7): 539–549.

27. Møller S, Hove JD, Dixen U et al. New insights into cirrhotic cardiomyopathy. Int J Cardiol 2013; 167(4): 1101–1108.

28. Simonneau G, Gatzoulis MA, Adatia I et al. Updated Clinical Classification of Pulmonary Hypertension. J Am Coll Cardiol. 2013; 62(25 Suppl): D34-D41.

29. Luknár M, Štefanková I, Goncalvesová R. Portopulmonálna artériová hypertenzia — opis prípadu a literárny prehad. Cardiol 2008; 17(1): 33–38.