State-of-the-Art Paper
Cardiohepatic Interactions in Heart Failure: An Overview and Clinical Implications

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Heart failure (HF) is a major public health problem leading to frequent hospitalizations, impaired quality of life, and shortened life expectancy. Heart failure leads to a chronic inability to meet metabolic requirements of end organs or skeletal muscle. Current literature lacks comprehensive descriptions of HF effects on hepatic function. In this review paper, we summarize the literature that is available in hopes of highlighting the key differences in clinical presentation, histological findings, and biochemical profiles of patients who present with both acute and chronic liver injury secondary to HF. We further discuss the use of liver function tests as prognostic markers in patients with HF, as well as the implications of liver injury on drug metabolism in this patient population. Finally, we provide recommendations regarding the management of both types of liver injury in HF patients.

Key Words

drug metabolism
heart failure
liver injury secondary to heart failure
prognostic markers

Abbreviations and Acronyms

ACLI
acute cardiogenic liver injury
ALT
alanine aminotransferase
GGT
gamma-glutamyl transpeptidase
HF
heart failure
LDH
lactate dehydrogenase
LFT
liver function test
LVAD
left ventricular assist device
MELD
model for end-stage liver disease
modMELD
modified model for end-stage liver disease
NYHA
New York Heart Association
TR
tricuspid regurgitation

Cited by (0)

Dr. Patel has received research funding (significant) from Medtronic, Inc. Dr. Felker has received research funding (significant) from Amgen, BG Medicine, Cytokinetics, Johnson & Johnson, Roche Diagnostics, and Otsuka; and consulting for Amgen, Cytokinetics, Roche Diagnostics, Otsuka (all modest), and Novartis (significant). Dr. Rogers has received consulting or other services (including Continuing Medical Education) from Bayer AG, Boston Scientific Corporation, Medtronic, Inc., and Thoratec Corporation (all modest). Dr. Hernandez has received research funding from Amylin, Bristol-Myers Squibb, Johnson & Johnson, and Portola Pharmaceuticals (all significant); and consulting for AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Ortho-McNeil-Janssen Pharmaceuticals, and Corthera (all modest). Dr. Hernandez was supported, in part, by funding (grant U19HS021092) from the Agency for Healthcare Research and Quality. Drs. Samsky and DeWald have reported they have no relationships relevant to the contents of this paper to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.