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01 October 2011

Predictors of cardiac hepatopathy in patients with right heart failure

Sherry MegallaABCDEF, Dvorah HoltzmanABCDEF, Wilbert S. AronowDEF, Reza NazariABCDEF, Svetlana KorenfeldABCDEF, Aron SchwarczABCDEF, Ythan GoldbergABCDEF, Daniel M. SpevackABCDEFG

DOI: 10.12659/MSM.881977

Med Sci Monit 2011; 17(10): CR537-541

Abstract

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.

Keywords: Hypertension, Pulmonary - complications, Hypertension, Heart Valve Diseases - complications, Heart Failure - etiology, Echocardiography, Cross-Sectional Studies, Bilirubin - blood, Aspartate Aminotransferases - blood, Alkaline Phosphatase - blood, Liver Diseases - pathology, Logistic Models

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750