Ali Saad A, Frick Kyle
Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
JACC Basic Transl Sci. 2025 Jul;10(7):101314. doi: 10.1016/j.jacbts.2025.101314.
Cardiac dysfunction in the setting of cirrhosis is often overlooked despite its impact on contractility, diastolic dysfunction, and electrophysiological abnormalities. This review examines the complex interactions of the cardiohepatic axis, with a particular focus on how liver disease impacts heart function. We highlight the roles of portal hypertension, systemic inflammation, hemodynamic changes, and neurohormonal signaling to shed light on this important connection. The underlying mechanisms for impaired cardiac performance involve both molecular and structural changes. Diagnosis remains challenging because it is frequently subclinical; however, advanced imaging, biomarkers, and electrocardiographic changes have improved early detection. Clinically, this syndrome has significant implications, particularly in decompensated cirrhosis and periods of increased myocardial stress. Although no standardized treatment guidelines exist, orthotopic liver transplantation remains the most effective intervention and often results in cardiovascular recovery. A multidisciplinary approach between cardiologists, hepatologists, and transplant surgeons is crucial to improving patient outcomes and optimizing long-term management.
尽管肝硬化背景下的心脏功能障碍对心肌收缩力、舒张功能障碍和电生理异常有影响，但常常被忽视。本综述探讨了心-肝轴的复杂相互作用，特别关注肝脏疾病如何影响心脏功能。我们强调门静脉高压、全身炎症、血流动力学变化和神经激素信号传导的作用，以阐明这一重要联系。心脏功能受损的潜在机制涉及分子和结构变化。诊断仍然具有挑战性，因为它常常是亚临床的；然而，先进的影像学、生物标志物和心电图变化已改善了早期检测。临床上，这种综合征具有重大意义，尤其是在失代偿期肝硬化和心肌应激增加的时期。尽管不存在标准化的治疗指南，但原位肝移植仍然是最有效的干预措施，并且常常导致心血管功能恢复。心脏病专家、肝病专家和移植外科医生之间的多学科方法对于改善患者预后和优化长期管理至关重要。
