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Yogeswaran A, Zedler D, Richter MJ, Steinke S, Rako ZA, Kremer NC, Grimminger F, Seeger W, Ghofrani HA, Gall H, Tello K. Hepatorenal dysfunction in patients with chronic thromboembolic pulmonary hypertension. Front Med (Lausanne) 2023; 10:1207474. [PMID: 37547612 PMCID: PMC10399740 DOI: 10.3389/fmed.2023.1207474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Background Cardiac interactions with organs such as the liver or kidneys have been described in different cardiovascular diseases. However, the clinical relevance of hepatorenal dysfunction in chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We determined the association of hepatorenal dysfunction (measured using the Model for End-stage Liver Disease Sodium [MELDNa] score) with right heart function and survival in patients with CTEPH. Methods We analyzed all patients with CTEPH in the Giessen Pulmonary Hypertension Registry who had available MELDNa scores and were not taking vitamin K antagonists. The MELDNa score was calculated as MELD score - serum Na - (0.025 * MELD score * (140 - serum Na)) + 140; the MELD score was calculated as 10*(0.957*ln(creatinine)+0.378*ln(bilirubin)+1.12*ln(International Normalized Ratio))+6.43. Results Seventy-two patients were included (74% female; median [Q1, Q3] MELDNa: 9 [6, 11]). MELDNa correlated well with right atrial and ventricular function and pulmonary hemodynamics. Forward regression analysis revealed that hepatorenal dysfunction mainly depends on right atrial strain and tricuspid regurgitation, but not right ventricular systolic dysfunction. Hepatorenal dysfunction predicted mortality at baseline and follow-up (adjusted hazard ratios [95% confidence intervals] per unit increase of MELDNa: 1.6 [1.1, 2.4] and 1.8 [1.1, 2.9], respectively). Changes in hepatorenal function also predicted mortality. Conclusion Hepatorenal dysfunction in CTEPH is primarily associated with venous congestion rather than cardiac forward failure. As a surrogate parameter for hepatorenal dysfunction, MELDNa is a simple method to identify at-risk patients at baseline and follow-up.
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Affiliation(s)
- Athiththan Yogeswaran
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Daniel Zedler
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Manuel J. Richter
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Sonja Steinke
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Zvonimir A. Rako
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Nils C. Kremer
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Friedrich Grimminger
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine, Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
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Eke C, Szabó A, Nagy Á, Párkányi B, Kertai MD, Fazekas L, Kovács A, Lakatos B, Hartyánszky I, Gál J, Merkely B, Székely A. Association between Preoperative Retrograde Hepatic Vein Flow and Acute Kidney Injury after Cardiac Surgery. Diagnostics (Basel) 2022; 12:diagnostics12030699. [PMID: 35328250 PMCID: PMC8946915 DOI: 10.3390/diagnostics12030699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/05/2022] Open
Abstract
Key questions: Is there a predictive value of hepatic venous flow patterns for postoperative acute kidney injury (AKI) after cardiac surgery? Key findings: In patients who underwent cardiac surgery, retrograde hepatic venous waves (A, V) and their respective ratio to anterograde waves showed a strong association with postoperative AKI, defined as the percentage change of the highest postoperative serum creatinine from the baseline preoperative concentration (%ΔCr). The velocity time integral (VTI) of the retrograde A wave and the ratio of the retrograde and anterograde waves’ VTI were independently associated with AKI after adjustment for disease severity. Take-home message: A higher ratio of retrograde/antegrade waves in hepatic venous retrograde waves, which are related to hepatic stasis, may predict AKI after cardiac surgery. Introduction: Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Pulsatility of the inferior caval vein was used to predict the risk of acute kidney injury (AKI) after cardiac surgery. Aims: Our objective was to evaluate the association between preoperative hepatic venous flow patterns and the risk of AKI in patients after cardiac surgery. Methods: This prospective, observational study included 98 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2018, and 31 March 2020, at a tertiary heart center. In addition to a routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves in the common hepatic vein with Doppler ultrasound. Our primary outcome measure was postoperative AKI, defined as the percentage change of the highest postoperative serum creatinine from the baseline preoperative concentration (%ΔCr). The secondary outcome was AKI, defined by KDIGO (Kidney Disease Improving Global Outcomes) criteria. Results: The median age of the patients was 69.8 years (interquartile range [IQR 25−75] 13 years). Seventeen patients (17.3%) developed postoperative AKI based on the KDIGO. The VTI of the retrograde A waves in the hepatic veins showed a strong correlation (B: 0.714; p = 0.0001) with an increase in creatinine levels after cardiac surgery. The velocity time integral (VTI) of the A wave (B = 0.038, 95% CI = 0.025−0.051, p < 0.001) and the ratio of VTI of the retrograde and anterograde waves (B = 0.233, 95% CI = 0.112−0.356, p < 0.001) were independently associated with an increase in creatinine levels. Conclusions: The severity of hepatic venous regurgitation can be a sign of venous congestion and seems to be related to the development of AKI.
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Affiliation(s)
- Csaba Eke
- Károly Rácz School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary; (C.E.); (A.S.); (Á.N.)
| | - András Szabó
- Károly Rácz School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary; (C.E.); (A.S.); (Á.N.)
| | - Ádám Nagy
- Károly Rácz School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary; (C.E.); (A.S.); (Á.N.)
| | - Boglár Párkányi
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Miklós D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
| | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (L.F.); (A.K.); (B.L.); (I.H.); (B.M.)
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (L.F.); (A.K.); (B.L.); (I.H.); (B.M.)
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (L.F.); (A.K.); (B.L.); (I.H.); (B.M.)
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (L.F.); (A.K.); (B.L.); (I.H.); (B.M.)
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary;
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (L.F.); (A.K.); (B.L.); (I.H.); (B.M.)
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary;
- Correspondence:
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Relationship between right atrial pressure and the Model for End-Stage Liver Disease (MELD) score in patients with advanced heart failure. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:1-7. [PMID: 35444854 PMCID: PMC8990151 DOI: 10.5606/tgkdc.dergisi.2022.22254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
Background
This study aims to investigate the association between right atrial pressure and the Model for End-Stage Liver Disease score and to evaluate the ability of this scoring system to accurately predict the value of right atrial pressure.
Methods
Between April 2016 and November 2018, a total of 137 patients (118 males, 19 females; median age: 49 years; range, 40 to 54 years) with advanced heart failure who were candidates for left ventricular assist device implantation or heart transplantation were retrospectively analyzed. We developed a formula calculated by using the biochemical and cardiac catheterization parameters of the patients.
Results
There was a strong correlation between the right atrial pressure and the scores (r=0.510, p<0.001). The estimated right atrial pressure was calculated as "2 + (0.92 x Model for End-Stage Liver Disease Score)" (unstandardized coefficient 0.920, t value 7.674, p<0.001). The Model for End-Stage Liver Disease score was found to be an independent predictor of high right atrial pressure (odds ratio=1.491, 95% confidence interval: 1.244-1.786, p<0.001). The calculated area under the curve was 0.789 (95% confidence interval: 0.710-0.867, p<0.001) and the cut-off value of the Model for End-Stage Liver Disease score in the prediction of high right atrial pressure was 10.5 with 75% sensitivity and 73% specificity.
Conclusion
We define a method to calculate right atrial pressure obtained by using the Model for End-Stage Liver Disease score without the need for cardiac catheterization during the hospitalization and follow-up period of patients with advanced heart failure.
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Acar RD, Acar Ş, Doğan C, Bayram Z, Karaduman A, Uysal S, Akbal ÖY, Hakgör A, Kaymaz C, Özdemir N. The TAPSE/PASP ratio and MELD score in patients with advanced heart failure. Herz 2020; 46:75-81. [PMID: 31965196 DOI: 10.1007/s00059-019-04879-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/13/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to explore the relationship between the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio and model for end-stage liver disease (MELD) score in patients with advanced heart failure. METHODS A total of 103 patients with advanced heart failure evaluated for candidacy for heart transplantation were included in this study. TAPSE was measured by M‑mode echocardiography and cardiac catheterization was performed. TAPSE/ PASP ratio and MELD score were calculated. RESULTS The median age of patients was 49 (40.5-54) years and the majority were male (92%). The percentage of patients with ischemic cardiomyopathy was 40%. The mean value of the group's MELD score was 10 ± 3.3 and the median value of TAPSE/PASP 0.24 (0.18-0.34). There was a moderate negative correlation between TAPSE/PASP and MELD score (r: -0.38, p < 0.001). Right atrial pressure (RAP) and left ventricular end-diastolic pressure (LVEDP) were also negatively correlated with TAPSE/PASP (correlation coefficients were r: -0.562 and r: -0.575, respectively). In patients with a lower TAPSE/PASP ratio, MELD score, LVEDP and RAP were higher and tricuspid regurgitation was more severe, but there were no significant differences between cardiac output (CO) and mean aortic pressure (mean BP). The presence of ischemia was found to be an independent predictor for lower values of TAPSE/PASP. CONCLUSION The lower TAPSE/PASP obtained on echocardiography may be a sign of the multi-organ failure defined as a high MELD score in patients with advanced heart failure.
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Affiliation(s)
- Rezzan Deniz Acar
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey.
| | - Şencan Acar
- Department of Internal Medicine, Memorial Hospital, Istanbul, Turkey
| | - Cem Doğan
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Zübeyde Bayram
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Ahmet Karaduman
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Samet Uysal
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Aykun Hakgör
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Cihangir Kaymaz
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
| | - Nihal Özdemir
- Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey
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Prognostic scales in advanced heart failure. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:183-187. [PMID: 30310398 PMCID: PMC6180023 DOI: 10.5114/kitp.2018.78444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/04/2018] [Indexed: 12/28/2022]
Abstract
Heart transplantation (HT) is the treatment of choice for patients with advanced heart failure (HF) who remain symptomatic despite optimal medical therapy. Due to the shortage of organs for transplantation and constantly increasing number of patients placed on waiting lists, accurate risk stratification is a crucial element of management in this population. Prognostic scales allow one to evaluate the patient prognosis, estimate the potential benefits of therapy and identify those patients most likely to benefit from advanced methods of treatment. In this review, we describe prognostic scales in advanced HF, concentrating on commonly used tools – the Heart Failure Survival Score (HFSS) and Seattle Heart Failure Model (SHFM) – as well as on the new promising scales for evaluating waiting list mortality and post-transplant outcomes.
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Holndonner-Kirst E, Nagy A, Czobor NR, Fazekas L, Lex DJ, Sax B, Hartyanszky I, Merkely B, Gal J, Szekely A. Higher Transaminase Levels in the Postoperative Period After Orthotopic Heart Transplantation Are Associated With Worse Survival. J Cardiothorac Vasc Anesth 2018; 32:1711-1718. [DOI: 10.1053/j.jvca.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/11/2022]
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Moraes ACOD, Fonseca-Neto OCLD. THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES IN CARDIAC TRANSPLANTATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1370. [PMID: 29972398 PMCID: PMC6044199 DOI: 10.1590/0102-672020180001e1370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.
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Nadziakiewicz P, Szyguła-Jurkiewicz B, Pacholewicz J, Zakliczyński M, Przybyłowski P, Krauchuk A, Łowicka M, Zembala M. Predictive Value of Models for End-Stage Liver Disease Score in Patients With Pulsatile Flow POLVAD MEV Left Ventricular Assist Device Support. Transplant Proc 2018; 50:2075-2079. [PMID: 30177112 DOI: 10.1016/j.transproceed.2018.02.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Model for End-Stage Liver Disease (MELD) score predicts multisystem dysfunction and death in patients with heart failure (HF). Left ventricular assist devices (LVADs) have been used for the treatment of end-stage HF. AIM OF THE STUDY We evaluated the prognostic values of MELD, MELD-XI, and MELD-Na scores in patients with POLVAD MEV LVAD. MATERIALS AND METHODS We retrospectively analyzed data of 25 consecutive pulsatile flow POLVAD MEV LVAD patients (22 men and 3 women) divided in 2 groups: Group S (survivors), 20 patients (18 men and 2 women), and Group NS (nonsurvivors), 5 patients (4 men and 1 woman). Patients were qualified in INTERMACS class 1 (7 patients) and class 2 (18 patients). Clinical data and laboratory parameters for MELD, MELD-XI, and MELD-Na score calculation were obtained on postoperative days 1, 2, and 3. Study endpoints were mortality or 30 days survival. MELD scores and complications were compared between Groups S and NS. RESULTS 20 patients survived, and 5 (4 men and 1 woman) died during observation. Demographics did not differ. MELD scores were insignificantly higher in patients who died (Group 2). Values were as follows: 1. MELD preoperatively (21.71 vs 15.28, P = .225) in day 1 (22.03 vs 17.14, P = .126), day 2 (20.52 vs 17.03, P = .296); 2. MELD-XI preoperatively (19.28 vs 16.39, P = .48), day 1 (21.55 vs 18.14, P = .2662), day 2 (20.45 vs 17.2, P = .461); and 3. MELD-Na preoperatively (20.78 vs 18.7, P = .46), day 1 23.68 vs 18.12, P = .083), day 2 (22.00 vs 19.19, P = .295) consecutively. CONCLUSIONS The MELD scores do not identify patients with pulsatile LVAD at high risk for mortality in our series. Further investigation is needed.
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Affiliation(s)
- P Nadziakiewicz
- Department of Cardiac Anaesthesia and Intensive Care SUM, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - B Szyguła-Jurkiewicz
- Clinical Department of Cardiac Anaesthesia and Intensive Care (SMDZ), Zabrze, Medical University of Silesia, Katowice, Poland
| | - J Pacholewicz
- Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - M Zakliczyński
- Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - P Przybyłowski
- Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - A Krauchuk
- Department of Anaesthesiology, Szpital Specjalistyczny, Zabrze, Poland
| | - M Łowicka
- Department of Cardiac Anaesthesia and Intensive Care SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - M Zembala
- Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland
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Correale M, Tarantino N, Petrucci R, Tricarico L, Laonigro I, Di Biase M, Brunetti ND. Liver disease and heart failure: Back and forth. Eur J Intern Med 2018; 48:25-34. [PMID: 29100896 DOI: 10.1016/j.ejim.2017.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 12/18/2022]
Abstract
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver. Hepatic involvement after heart failure, its pathophysiology, clinical presentation (congestive and ischemic hepatopathy), laboratory and echocardiographic prognostic markers are discussed; likewise, hepatic diseases influencing cardiac function (cirrhotic cardiomyopathy). Several clinical conditions (congenital, metabolic and infectious causes) possibly affecting simultaneously liver and heart have been also discussed. Cardiovascular drug therapy may present important side effects on the liver and hepato-biliary drug therapy on heart and vessels; post-transplantation immunosuppressive drugs may show reciprocal cardio-hepatotoxicity. A heart-liver axis is drafted by inflammatory reactants from the heart and the liver, and liver acts a source of energy substrates for the heart.
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Affiliation(s)
| | - Nicola Tarantino
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Rossella Petrucci
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Lucia Tricarico
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Irma Laonigro
- Ospedali Riuniti University Hospital, Foggia, Italy.
| | - Matteo Di Biase
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
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