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Predictors of cardiac hepatopathy in patients with right heart failure
Sherry Megalla1, Dvorah Holtzman, Wilbert S Aronow
1Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
Cardiac hepatopathy (CH) in right heart failure patients is linked to elevated right ventricular diastolic pressure, suggesting congestion. In some cases without left heart failure, low cardiac output also contributes to CH.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
Background:
- Cardiac hepatopathy (CH) is a complication in some patients with right heart failure.
- Its development is attributed to hepatic venous congestion and arterial ischemia.
- Understanding CH's characteristics is crucial for managing right heart failure.
Purpose of the Study:
- To define the clinical and hemodynamic characteristics associated with cardiac hepatopathy.
- To identify factors contributing to the development of CH in patients with right heart dysfunction.
Main Methods:
- Retrospective cross-sectional analysis of 188 patients.
- Inclusion criteria: echocardiography showing right ventricular (RV) hypokinesis or dilatation within 30 days of right heart catheterization.
- Exclusion of non-cardiac causes of hepatopathy; chart review for clinical data.
Main Results:
- Etiologies for right heart dysfunction included left heart failure, shunt, pulmonary hypertension, and valvular disease.
- Higher RV diastolic pressure and RV dysfunction not due to left heart failure were associated with CH.
- Low cardiac output was linked to CH only in patients without left heart failure.
Conclusions:
- Elevated RV diastolic pressure is the primary factor in CH, indicating congestion.
- Low cardiac output may contribute to CH pathophysiology in specific patient groups without left heart failure.
Background:
Some 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/Methods:
A 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.
Results:
In 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.
Conclusions:
CH 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.
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