Predictors of cardiac hepatopathy in patients with right heart failure

Abstract

SummaryBackgroundSome patients with right heart failure develop cardiac hepatopathy (CH). The pathophysiology of CH is thought to be secondary to hepatic venous congestion and arterial ischemia. We sought to define the clinical and hemodynamic characteristics associated with CH.Material/MethodsA retrospective cross sectional analysis was performed in which subjects were identified from our institutional cardiology database if echocardiography showed either right ventricular (RV) hypokinesis or dilatation, and was performed within 30 days of right heart catheterization. A chart review was then performed to identify patient clinical characteristics and to determine if the patients had underlying liver disease. Subjects with non-cardiac causes for hepatopathy were excluded.ResultsIn 188 included subjects, etiology for right heart dysfunction included left heart failure (LHF), shunt, pulmonary hypertension, mitral- tricuspid- and pulmonic valvular disease. On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH. Low cardiac output was associated with CH only amongst those without LHF.ConclusionsCH is most often seen in subjects with elevated RV diastolic pressure suggesting a congestive cause in most cases. CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity

“…In patients with severe heart failure, particularly right heart failure, hepatic injury results from chronic congestion, with or without superimposed decline in hepatic arterial perfusion. 6 Although this pathologic entity has been well known for decades, there has been no useful grading system for prospective and comparative studies, resulting in a lack of consistent reporting parameters for liver histopathology that potentially hinders the communication of appropriate information to the clinicians. In this study, we have proposed a simple scoring system-the congestive hepatic fibrosis score-and have demonstrated that this score correlates well with echocardiography-derived right atrial pressure as well as both right atrial and right ventricular dilatation.…”

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

“…As RV dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, leading to progressive venous congestion . Venous congestion and increased central venous pressure also lead to impairment of renal, intestinal, and hepatic function, which are important predictors of poor prognosis in patients with acute RV failure …”

Congenital chylothorax and pulmonary hypertension complicated with heart failure and hepatopathy

“…CH is associated with increased morbidity and mortality in patients with cardiac dysfunction. Previous studies have shown that the most noticeable hemodynamic features are elevated RV, right atrial and hepatic venous pressures in patients with CH 6,7 . Only aminotransferase levels correlate with right heart failure, particularly in patients with acute cardiac dysfunction 6 .…”

“…Previous studies have shown that the most noticeable hemodynamic features are elevated RV, right atrial and hepatic venous pressures in patients with CH. 6,7 Only aminotransferase levels correlate with right heart failure, particularly in patients with acute cardiac dysfunction. 6 In contrast, Van Deursen et al found that all abnormal liver function tests were related to high central venous pressure (CVP) but that higher CVP is mainly related to g-GTP and DB, whereas AST, ALT, and TB are associated with low cardiac index.…”