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Cardiohepatic Syndrome: Liver Injury in Decompensated Heart Failure

  • Decompensated Heart Failure (JE Ho, Section Editor)
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Abstract

Heart failure (HF) is a major healthcare concern. Acute HF carries a high mortality and a high rehospitalisation rate. HF has a variety of detrimental effects on other organs. In recent years, the interactions between heart failure and the kidney have been the subject of significant investigations; this interaction, defined as “cardiorenal syndrome”, is relatively well characterized. We describe here another interaction between the heart and the liver, the “cardiohepatic syndrome”, in acute HF patients. Recent publications have shown that liver function test (LFT) abnormalities were associated with AHF severity. Clinical signs of systemic congestion were found to be associated with cholestasis, when signs of hypoperfusion were associated with liver cytolysis. Defining the LFT profile in AHF may play an important role in the future management of AHF patients.

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References

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  1. Fang J, Mensah GA, Croft JB, Keenan NL (2008) Heart failure-related hospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol 52(6):428–34.

    Article  PubMed  Google Scholar 

  2. Nieminen MS, Harjola VP (2005) Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 96(6A):5G–10.

    Article  PubMed  Google Scholar 

  3. Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93(9):1137–46.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al (2014) The Global Health and Economic Burden of Hospitalizations for Heart Failure: Lessons Learned from HHF Registries. J Am Coll Cardiol 63(12):1123–33. This review summarize data available on HF registries and HF burden.

  5. Lassus JP, Siirila-Waris K, Nieminen MS, Tolonen J, Tarvasmaki T, Peuhkurinen K et al (2013) Long-term survival after hospitalization for acute heart failure - differences in prognosis of acutely decompensated chronic and new-onset acute heart failure. Int J Cardiol 168(1):458–62.

    Article  PubMed  Google Scholar 

  6. Mebazaa A, Gheorghiade M, Pina IL, Harjola VP, Hollenberg SM, Follath F et al (2008) Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 36(1 Suppl):S129–39.

    Article  PubMed  Google Scholar 

  7. McCullough PA, Kellum JA, Haase M, Muller C, Damman K, Murray PT et al (2013) Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:82–98. This paper summarize the pathophysiology of the cardiorenal syndrome.

    Article  PubMed  Google Scholar 

  8. Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P et al (2006) Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 47(10):1987–96.

    Article  PubMed  Google Scholar 

  9. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al (2014) The Global Health and Economic Burden of Hospitalizations for Heart Failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63(12):1123–33.

    Article  PubMed  Google Scholar 

  10. Mebazaa A (2010) Congestion and cardiorenal syndromes. Contrib Nephrol 165:140–4.

    Article  PubMed  Google Scholar 

  11. Haase M, Muller C, Damman K, Murray PT, Kellum JA, Ronco C et al (2013) Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:99–116.

    Article  PubMed  Google Scholar 

  12. Cruz DN, Schmidt-Ott KM, Vescovo G, House AA, Kellum JA, Ronco C et al (2013) Pathophysiology of cardiorenal syndrome type 2 in stable chronic heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:117–36.

    Article  PubMed  Google Scholar 

  13. Bagshaw SM, Hoste EA, Braam B, Briguori C, Kellum JA, McCullough PA et al (2013) Cardiorenal syndrome type 3: pathophysiologic and epidemiologic considerations. Contrib Nephrol 182:137–57.

    Article  PubMed  Google Scholar 

  14. Tumlin JA, Costanzo MR, Chawla LS, Herzog CA, Kellum JA, McCullough PA et al (2013) Cardiorenal syndrome type 4: insights on clinical presentation and pathophysiology from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:158–73.

    Article  PubMed  Google Scholar 

  15. Mehta RL, Rabb H, Shaw AD, Singbartl K, Ronco C, McCullough PA et al (2013) Cardiorenal syndrome type 5: clinical presentation, pathophysiology and management strategies from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol 182:174–94.

    Article  PubMed  Google Scholar 

  16. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC et al (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53(7):589–96.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Batin P, Wickens M, McEntegart D, Fullwood L, Cowley AJ (1995) The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure. Eur Heart J 16(11):1613–8.

    CAS  PubMed  Google Scholar 

  18. van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA (2010) Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 16(1):84–90.

    Article  PubMed  Google Scholar 

  19. Kubo SH, Walter BA, John DH, Clark M, Cody RJ (1987) Liver function abnormalities in chronic heart failure. Influence of systemic hemodynamics. Arch Intern Med 147(7):1227–30.

    Article  CAS  PubMed  Google Scholar 

  20. Felder L, Mund A, Parker JG (1950) Liver function tests in chronic congestive heart failure. Circulation 2(2):286–97.

    Article  CAS  PubMed  Google Scholar 

  21. Samsky MD, Patel CB, DeWald TA, Smith AD, Felker GM, Rogers JG et al (2013) Cardiohepatic interactions in heart failure: an overview and clinical implications. J Am Coll Cardiol 61(24):2397–405.

    Article  PubMed  Google Scholar 

  22. Cassidy WM, Reynolds TB (1994) Serum lactic dehydrogenase in the differential diagnosis of acute hepatocellular injury. J Clin Gastroenterol 19(2):118–21.

    Article  CAS  PubMed  Google Scholar 

  23. Vasconcelos LA, de Almeida EA, Bachur LF (2007) Clinical evaluation and hepatic laboratory assessment in individuals with congestive heart failure. Arq Bras Cardiol 88(5):590–5.

    Article  PubMed  Google Scholar 

  24. Poelzl G, Ess M, Von der Heidt A, Rudnicki M, Frick M, Ulmer H (2013) Concomitant renal and hepatic dysfunctions in chronic heart failure: clinical implications and prognostic significance. Eur J Intern Med 24(2):177–82.

    Article  PubMed  Google Scholar 

  25. Allen LA, Felker GM, Pocock S, McMurray JJ, Pfeffer MA, Swedberg K et al (2009) 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 11(2):170–7. Large and well characterized chronic HF population.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Poelzl G, Ess M, Mussner-Seeber C, Pachinger O, Frick M, Ulmer H (2012) Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Invest 42(2):153–63.

    Article  CAS  PubMed  Google Scholar 

  27. Shinagawa H, Inomata T, Koitabashi T, Nakano H, Takeuchi I, Naruke T et al (2008) Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 72(3):364–9.

    Article  CAS  PubMed  Google Scholar 

  28. Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ et al (2012) 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 14(3):302–11.

    Article  CAS  PubMed  Google Scholar 

  29. Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ et al (2007) Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 297(17):1883–91.

    Article  CAS  PubMed  Google Scholar 

  30. Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S et al (2013) Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 34(10):742–9, This article suggest a mechanism for liver injury in a large AHF population.

    Article  PubMed  Google Scholar 

  31. Vyskocilova K, Spinarova L, Spinar J, Mikusova T, Vitovec J, Malek J et al (2014) Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. doi:10.5507/bp.2014.014.

  32. Mullens W, Abrahams Z, Skouri HN, Francis GS, Taylor DO, Starling RC et al (2008) Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 51(3):300–6.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Said Laribi declares that he has no conflict of interest.

Alexandre Mebazaa has received speaker’s honoraria from Alere, BRAHMS, Edwards, Orion, and Bayer.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Emergency Department, APHP, Groupe Hospitalier Saint Louis-Lariboisière, 75010, Paris, France

    Said Laribi

  2. Unit 942, BIOmarkers in CArdioNeuroVAScular Diseases, INSERM, 75010, Paris, France

    Said Laribi & Alexandre Mebazaa

  3. Univ Paris Diderot, Sorbonne Paris Cité, 75010, Paris, France

    Alexandre Mebazaa

  4. Department of Anesthesiology and Critical Care, APHP, Groupe hospitalier Saint Louis-Lariboisière, 75010, Paris, France

    Alexandre Mebazaa

  5. Department of Anesthesiology and Critical Care, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France

    Alexandre Mebazaa

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  1. Said Laribi
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  2. Alexandre Mebazaa
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Correspondence to Alexandre Mebazaa.

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Laribi, S., Mebazaa, A. Cardiohepatic Syndrome: Liver Injury in Decompensated Heart Failure. Curr Heart Fail Rep 11, 236–240 (2014). https://doi.org/10.1007/s11897-014-0206-8

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  • DOI: https://doi.org/10.1007/s11897-014-0206-8

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