The prevalence and prognostic significance of liver disease in chronic heart failure

Abstract

Heart failure (HF) is characterized by systemic hemodynamicchanges that negatively affect all organs, including liver.Large-scale clinical trials, which involved mostly patients withheart failure and reduced ejection fraction, showed the highprevalence of abnormal liver function tests that had poorprognosis. Patients with common comorbidities, such as obesity, diabetes mellitus, and arterial hypertension, frequentlypresent with both non-alcoholic fatty liver disease (NAFLD)and subclinical HF. The association between these two conditions, both leading to hepatic injury, was shown in severalstudies. The criteria for non-invasive diagnosis of cardiogenicliver damage, including fibrosis, are not established. Studiessuggested the correlation between liver stiffness measured byelastography and liver function test abnormalities in patientswith decompensated HF. Moreover, liver stiffness was a predictor of worse outcomes. However, liver stiffness thresholdsare not defined for patients with HF. The interpretation ofliver function test alterations in HF also remains ambiguous,and there is no unified classification of hepatic injury in HF.The role of NAFLD in patients with symptomatic HF is not wellunderstood and requires future research.