“Cardiac Hepatopathy”: A Review of Liver Dysfunction in Heart Failure

Shailja C. Shah and David A. Sass*

“Cardiac Hepatopathy”: A Review of Liver Dysfunction in Heart Failure

The unique dual circulation of the liver confers relative protection against ischemic
injury; however, low oxygen tension in the microcirculation (sinusoidal blood of the hepatic
acinus) may render hepatocytes in zone 3 relatively vulnerable to ischemic injury and necrosis.
Severe congestive heart failure is associated with two distinct forms of liver dysfunction under
the umbrella term “cardiac hepatopathy”.

The two entities include: jaundice related to passive
congestion (congestive hepatopathy from backward cardiac failure) and acute hepatocellular
necrosis caused by impaired hepatic perfusion (hypoxic hepatitis from forward cardiac failure).

This article provides a comprehensive, up-to-date review on the topic and focuses
on the epidemiology, pathology, pathogenesis, clinical manifestations,
diagnostic testing and treatment strategies pertaining to liver disease in circulatory failure.

The relationship between cardiac and hepatic dysfunction has been a well-recognized
entity for over two centuries. Yet, the complexity and nuances of the association still remain
a topic of intense interest and research. Studies dealing with this topic are relatively few, not
rarely with contradictory results.

There are several reasons for the variant results: heart failure etiology has changed over the years, being mainly related to rheumatic valvular disease in the earliest studies and to ischemic cardiomyopathy more recently.

Also, the outcome of heart failure has dramatically improved due to superior medical therapies, not to mention widespread use of heart transplantation. Thus, cardiac cirrhosis, once the paradigm of liver involvement in
heart failure, is now rare.

Liver Res Open J. 2015; 1(1): 1-10. doi: 10.17140/LROJ-1-101