Liver Function Abnormalities in Acute Heart Failure: A State-of-the-art Review from an International Expert Group.

Authors

Oliviana Geavlete, Andrew P Ambrosy, Alexandre Mebazaa, Sean P Collins, Jan Biegus, Marianna Adamo, John Teerlink, Giuseppe Mc Rosano, Petar Seferović, Razvan I Radu, Gianluigi Savarese, Beth Davison, Alexandru Ababei, Marija Polovina, Anika Naidu, Òscar Miró, Luca Monzo, Alberto Palazzuoli, Teodora Radu, Lars H Lund, Tuvia Ben Gal, Maurizio Volterrani, Ovidiu Chioncel, Gad Cotter, Mandeep R Mehra, Javed Butler, Andrew Js Coats, Vlad Iliescu

Published in

Cardiac failure review. Volume 12. Pages e17. Epub Jul 14, 2026.

Abstract

Acute heart failure (AHF) is a systemic condition characterised by multiorgan involvement that varies from subclinical to overt organ failure. The liver is particularly vulnerable due to its dual blood supply and sensitivity to haemodynamic and inflammatory disturbances. Abnormal liver function tests are highly prevalent in patients with AHF, reflecting major mechanisms: passive hepatic venous congestion from elevated central venous pressure, hepatocellular ischaemia from low cardiac output, systemic inflammation and poor metabolic status associated with cachexia. In patients with AHF, liver function tests at admission, during hospitalisation and at discharge are independently associated with rehospitalisation, cardiovascular and all-cause mortality. Persistent abnormalities after hospitalisation often reflect incomplete decongestion or irreversible structural liver changes. Therapeutic strategies focus on decongestion, optimisation of cardiac output and medication adjustments to avoid hepatotoxicity. Despite significant advances in understanding cardio-hepatic interactions, major gaps remain, including the lack of standardised definitions, limited mechanistic studies and the underrepresentation of patients with heart failure with preserved ejection fraction in contemporary research. Future research should explore targeted therapies to improve cardiohepatic interactions and patient outcomes.

PMID:
42495596
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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