Heart Disease and the Liver: Pathologic Evaluation

Gastroenterol Clin North Am. 2017 Jun;46(2):421-435. doi: 10.1016/j.gtc.2017.01.012.

Abstract

Liver injury due to acute and chronic heart failure has long been recognized. This article discusses the concepts of acute cardiogenic liver injury (ACLI) and cardiac or congestive hepatopathy (CH) along with their clinical manifestations and sequelae. Histologically, ACLI manifests as centrilobular hepatocellular necrosis, whereas CH is associated with centrilobular hepatocyte atrophy, dilated sinusoids, and perisinusoidal fibrosis, progressing to bridging fibrosis and ultimately cirrhosis. ACLI is associated with marked increases in aminotransferase levels, whereas CH is associated with a cholestatic pattern of laboratory tests. Certain cardiac medications have also been implicated as a cause of liver fibrosis.

Keywords: Acute cardiogenic liver injury; Cardiac cirrhosis; Congestive hepatopathy; Fontan; Liver.

Publication types

  • Review

MeSH terms

  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Aspartate Aminotransferases / blood
  • Fibrosis
  • Fontan Procedure
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / surgery
  • Heart Failure / complications*
  • Humans
  • L-Lactate Dehydrogenase / blood
  • Liver / pathology*
  • Liver Diseases / blood
  • Liver Diseases / etiology
  • Liver Diseases / pathology*
  • gamma-Glutamyltransferase / blood

Substances

  • L-Lactate Dehydrogenase
  • gamma-Glutamyltransferase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Alkaline Phosphatase