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Cardiac Syndromes in Liver Disease:A Clinical Conundrum

Journal of Clinical and Translational Hepatology 2023年第4期11卷 975-986页

作者： Milos Brankovic Paul Lee Nikolaos Pyrsopoulos Mark Klapholz Department of Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA Transatlantic Cardiovascular Study Group BloomfieldNJUSA Division of Gastroenterology and Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Cardiology Heart Failure Prevention and Treatment ProgramRutgers New Jersey Medical SchoolNewarkNJUSA

Understanding the interaction between the heart and liver is pivotal for managing patients in whom both organs are affected.Studies have shown that cardio-hepatic interactions are bidirectional and that their identification,assessment,and treatment remain challenging.Congestive hepatopathy is a condition that develops in the setting of long-standing systemic venous congestion.If left untreated,Congestive hepatopathy may lead to hepatic fibrosis.Acute cardiogenic liver injury develops as a combination of venous stasis and sudden arterial hypoperfusion due to cardiac,circulatory,or pulmonary failure.The treatment of both conditions should be directed toward optimizing the cardiac substrate.Hyperdynamic syndrome may develop in patients with advanced liver disease and lead to multiorgan failure.Cirrhotic cardiomyopathy or abnormalities in pulmonary vasculature,such as hepatopulmonary syndrome and portopulmonary hypertension may also develop.Each complication has unique treatment challenges and implications for liver transplantation.The presence of atrial fibrillation and atherosclerosis in liver disease brings another layer of complexity,particularly in terms of anticoagulation and statin use.This article provides an overview of cardiac syndromes in liver disease,focusing on current treatment options and future perspectives.

关键词： Liver disease Congestive hepatopathy Cardiogenic liver injury Cirrhotic cardiomyopathy Hepatopulmonary syndrome Portopulmonary hypertension

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congestive heart failure masquerading as acute abdomen:A case report

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Journal of Acute Disease 2022年第5期11卷 209-211页

作者： Eunizar Omar Yasheen Krishna Persand Department of Emergency Medicine Sengkang General HospitalSengkang 544886Singapore

Rationale:As an uncommon manifestation of congestive heart failure,Congestive hepatopathy requires an early diagnosis in order to render appropriate care.Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention,such as fluid boluses,that can potentially tip an already sick patient with poor reserves over into an extreme state.Patient’s Concern:A 65-year-old man was brought to the emergency department for excruciating abdominal pain,vomiting and jaundice.He also had lower limb pitting edema and was hypotensive en route.Diagnosis:Congestive hepatopathy.Interventions:Intravenous furosemide and fluid restriction.Outcomes:The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department.Lessons:It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies.In this case of acute decompensated congestive heart failure,early recognition of the cause makes a difference to the management.

关键词： Congestive hepatopathy Heart failure Cardiohepatic Acute abdomen Liver congestion

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Gravity assistance enables liver stiffness measurements to detect liver fibrosis under congestive circumstances

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World Journal of Hepatology 2022年第4期14卷 778-790页

作者： Takeshi Suda Ai Sugimoto Tsutomu Kanefuji Atsushi Abe Takeshi Yokoo Takahiro Hoshi Satoshi Abe Shinichi Morita Kazuyoshi Yagi Masashi Takahashi Shuji Terai Department of Gastroenterology and Hepatology Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalMinami Uonuma 949-7302NiigataJapan Division of Thoracic and Cardiovascular Surgery Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8122Japan Department of Gastroenterology and Hepatology Tsubame Rosai HospitalTsubame 959-1228NiigataJapan Department of Administration Joetsu-Area General Health Care CenterJoetsu 943-0803NiigataJapan Department of Preemptive Medicine for Digestive Diseases and Healthy Active Life Niigata University School of MedicineNiigata 951-8122Japan Division of Gastroenterology and Hepatology School of Medical and Dental SciencesNiigata UniversityNiigata 951-8122Japan

BACKGROUND As survival has been prolonged owing to surgical and medical improvements,liver failure has become a prognostic determinant in patients with congestive heart diseases.Congestive hepatopathy,an abnormal state of the liver as a result of congestion,insidiously proceed toward end-stage liver disease without effective biomarkers evaluating pathological progression.Regular measurements of shear wave elastography cannot qualify liver fibrosis,which is a prognosticator in any type of chronic liver disease,in cases of congestion because congestion makes the liver stiff without fibrosis.We hypothesized that the effects of congestion and fibrosis on liver stiffness can be dissociated by inducing architectural deformation of the liver to expose structural rigidity.To establish a strategy measuring liver stiffness as a reflection of architectural rigidity under congestion.METHODS Two-dimensional shear wave elastography(2dSWE)was measured in the supine(Sp)and left decubitus(Ld)positions in 298 consecutive cases as they were subjected to an ultrasound study for various liver diseases.Regions of interest were placed at twelve sites,and the median and robust coefficient of variation were calculated.Numerical data were compared using the Mann-Whitney U or Kruskal-Wallis test followed by Dunn's post-hoc multiple comparisons.The inferior vena cava(IVC)diameters at different body positions were compared using the Wilcoxon matched pairs signed rank test.The number of cases with cardiothoracic ratios greater than or not greater than 50%was compared using Fisher’s exact test.A correlation of 2dSWE between different body positions was evaluated by calculating Spearman correlation coefficients.RESULTS The IVC diameter was significantly reduced in Ld in subjects with higher 2dSWE values in Ld(LdSWE)than in Sp(SpSWE)(P=0.007,(average±SD)13.9±3.6 vs 13.1±3.4 mm)but not in those with lower LdSWE values(P=0.32,13.3±3.5 vs 13.0±3.5 mm).In 81 subjects,SpSWE was increased or decreased in Ld beyond the magnitude of robust coefficient o

关键词： Shear wave elastography Inferior vena cava diameter Congestive hepatopathy Liver fibrosis Body positions Fibrosis-4 index

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