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Redox Imbalance in the Cardiohepatic Syndrome: The Emerging Role of Oxidative Stress in Cirrhosis-Associated Cardiac

Nikola Blagojevic1, Dragana Blagojevic2, Ana Matovic1

  • 1Clinic for Internal Medicine, Cardiology Department, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", 11000 Belgrade, Serbia.

Antioxidants (Basel, Switzerland)
|May 4, 2026
PubMed

Insights

Cirrhosis affects multiple systems, including the heart, leading to cardiac dysfunction. Oxidative stress drives these changes, but new antioxidant therapies show promise for managing cardiohepatic syndrome.

Area of Science:

  • Cardiology
  • Hepatology
  • Oxidative Stress Research

Background:

  • Cirrhosis is a multisystemic disease impacting cardiovascular, renal, pulmonary, metabolic, and immune systems.
  • Cirrhotic cardiomyopathy, portopulmonary hypertension, and right ventricular failure are under-recognized cardiac consequences.
  • Oxidative stress (OS) is a key mechanism linking hepatic fibrogenesis and myocardial remodeling.

Purpose of the Study:

  • To explore the role of redox imbalance in cardiohepatic syndrome.
  • To highlight the link between hepatic fibrogenesis and myocardial remodeling via oxidative stress.
  • To discuss the diagnostic and therapeutic potential of targeting redox imbalance.

Main Methods:

  • Review of current literature on cirrhosis, cardiac dysfunction, and oxidative stress.
  • Analysis of mechanisms including mitochondrial injury, NADPH oxidase activation, and ferroptosis.
  • Examination of redox biomarkers for early detection of cardiac involvement.

Main Results:

  • Oxidative stress induces mitochondrial injury, NO dysregulation, ferroptosis, and inflammation, leading to diastolic dysfunction, fibrosis, and electrophysiological abnormalities.
  • Specific biomarkers (MDA, NOX2, GSH/GSSG, sST2, NT-proBNP, 8-isoprostanes) show potential for detecting subclinical cardiac issues.
  • Impaired RV-pulmonary artery coupling is a significant consequence of these redox alterations.

Conclusions:

  • Redox imbalance is central to the development of cardiohepatic syndrome.
  • Biomarkers of oxidative stress can aid in early diagnosis and monitoring of cardiac involvement in cirrhosis.
  • Antioxidant therapies targeting mitochondria, NADPH oxidase, and ferroptosis offer potential therapeutic strategies.

Keywords:
cardiohepatic syndromecirrhosis-associated cardiac dysfunctionoxidative stress

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