Cardiac Hepatopathy

Liver disease resulting from heart disease has generally been referred as “cardiac hepatopathy.” The two main forms of cardiac hepatopathy are acute cardiogenic liver injury (ACLI) and congestive hepatopathy (CH). ACLI most commonly occurs in the setting of acute cardiocirculatory failure, whereas CH results from passive venous congestion in the setting of chronic right-sided heart failure (HF). Both conditions often coexist and potentiate the deleterious effects of each other on the liver. In CH, the chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis (“cardiac cirrhosis”) and hepatocellular carcinoma. The differentiation between congestion and fibrosis currently represents an unmet need and a growing research area. Although cardiac cirrhosis may only arise after several decades of ongoing injury, the long-term survival of cardiac patients due to advances in medical and surgical treatments is responsible for the increased number of liver complications in this setting. Eventually, the liver disease could become as clinically relevant as the cardiac disease and further complicate its management.