Prognostic value of liver assessment (including liver stiffness measurement) in cardiovascular diseases

There are emerging data on the mutual relationship between heart failure (HF) and liver impairment. In HF patients, hepatic injury termed as cardiac hepatopathy can be the result of passive congestion and diminished perfusion. Congestive hepatopathy and acute cardiogenic liver injury (ischemic hepatitis) are well-recognized forms of hepatic injury caused by HF. In addition, liver disease such as nonalcoholic fatty liver disease (NAFLD) affects multiple systems and causes a great deal of cardiovascular, including ischemic, disease, as well as subclinical myocardial remodeling and dysfunction that may carry an increased risk for developing HF. Assessment of liver status is an important aspect in the risk stratification of HF. Abnormalities in liver function tests, synthetic function, and fibrosis markers are associated with the severity of HF and are useful biomarkers to predict outcomes in HF. Ultrasound elastography may detect liver congestion and impairment more sensitively than routine laboratory tests. Evaluation of liver status by these modalities may be a useful adjunct to HF management.