Brankovic Milos, Lee Paul, Pyrsopoulos Nikolaos, Klapholz Mark
Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
Transatlantic Cardiovascular Study Group, Bloomfield, NJ, USA.
J Clin Transl Hepatol. 2023 Aug 28;11(4):975-986. doi: 10.14218/JCTH.2022.00294. Epub 2023 Feb 1.
Understanding the interaction between the heart and liver is pivotal for managing patients in whom both organs are affected. Studies have shown that cardio-hepatic interactions are bidirectional and that their identification, assessment, and treatment remain challenging. Congestive hepatopathy is a condition that develops in the setting of long-standing systemic venous congestion. If left untreated, congestive hepatopathy may lead to hepatic fibrosis. Acute cardiogenic liver injury develops as a combination of venous stasis and sudden arterial hypoperfusion due to cardiac, circulatory, or pulmonary failure. The treatment of both conditions should be directed toward optimizing the cardiac substrate. Hyperdynamic syndrome may develop in patients with advanced liver disease and lead to multiorgan failure. Cirrhotic cardiomyopathy or abnormalities in pulmonary vasculature, such as hepatopulmonary syndrome and portopulmonary hypertension may also develop. Each complication has unique treatment challenges and implications for liver transplantation. The presence of atrial fibrillation and atherosclerosis in liver disease brings another layer of complexity, particularly in terms of anticoagulation and statin use. This article provides an overview of cardiac syndromes in liver disease, focusing on current treatment options and future perspectives.
了解心脏与肝脏之间的相互作用对于治疗同时累及这两个器官的患者至关重要。研究表明，心-肝相互作用是双向的，对其进行识别、评估和治疗仍然具有挑战性。充血性肝病是在长期全身性静脉淤血情况下发生的一种病症。如果不进行治疗，充血性肝病可能会导致肝纤维化。急性心源性肝损伤是由于心脏、循环或肺功能衰竭导致静脉淤滞和突然的动脉灌注不足共同作用而发生的。这两种病症的治疗都应致力于优化心脏底物。高动力综合征可能在晚期肝病患者中出现并导致多器官衰竭。肝硬化性心肌病或肺血管异常，如肝肺综合征和门肺高压也可能发生。每种并发症都有独特的治疗挑战以及对肝移植的影响。肝病患者出现心房颤动和动脉粥样硬化会带来另一层复杂性，尤其是在抗凝和他汀类药物使用方面。本文概述了肝病中的心脏综合征，重点介绍了当前的治疗选择和未来展望。
