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Liver Function Abnormalities in Acute Heart Failure: A State-of-the-art Review from an International Expert Group
Oliviana Geavlete1,2, Andrew P Ambrosy3,4, Alexandre Mebazaa5
1Cardiac Care Unit, Emergency Institute of Cardiovascular Diseases Prof Dr CC Iliescu Bucharest, Romania.
Cardiac Failure Review
|July 24, 2026
Summary
Acute heart failure (AHF) impacts multiple organs, especially the liver, due to congestion and low blood flow. Liver function tests in AHF predict mortality and rehospitalization, highlighting the importance of managing cardio-hepatic interactions.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Acute heart failure (AHF) is a systemic condition affecting multiple organs, with the liver being particularly vulnerable.
- Abnormal liver function tests are common in AHF, stemming from hepatic venous congestion, hepatocellular ischemia, inflammation, and cachexia.
Purpose of the Study:
- To investigate the prevalence and prognostic significance of liver dysfunction in patients with acute heart failure.
- To explore the underlying mechanisms of liver injury in AHF and identify therapeutic targets.
Main Methods:
- Analysis of liver function tests at admission, during hospitalization, and at discharge in AHF patients.
- Correlation of liver function test abnormalities with clinical outcomes, including rehospitalization and mortality.
Main Results:
- Liver function test abnormalities in AHF are independently associated with increased risk of rehospitalization, cardiovascular events, and all-cause mortality.
- Persistent liver function abnormalities post-hospitalization may indicate incomplete decongestion or irreversible liver damage.
Conclusions:
- Liver dysfunction is a critical indicator of prognosis in AHF patients.
- Optimizing cardiac function, managing congestion, and avoiding hepatotoxicity are key therapeutic strategies.
- Further research is needed to address knowledge gaps in cardio-hepatic interactions, particularly in heart failure with preserved ejection fraction.
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