Heart-Liver Interactions: Pathophysiology and Diagnosis of Hypoxic Hepatitis, Congestive Hepatopathy, and Cirrhotic Cardiomyopathy.
7 affiliations
- 1Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- 2Clinic for Internal Medicine, Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", 11040 Belgrade, Serbia.
- 3Clinic for Gastroenterohepatology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
- 4Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
- 5Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- 6Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
- 7Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Abstract
The heart and liver are closely interconnected through complex hemodynamic, neurohumoral, inflammatory, and metabolic mechanisms. Dysfunction of either organ may adversely affect the other, giving rise to a broad spectrum of cardiohepatic disorders with important diagnostic and prognostic implications. This narrative review is based on a literature search strategy of PubMed and the Web of Science Core Collection covering publications from January 2000 through June 2026, with a focus on hypoxic hepatitis, congestive hepatopathy, and cirrhotic cardiomyopathy. Cardiac diseases may induce liver injury through acute hypoperfusion or chronic venous congestion, resulting in distinct clinical entities characterized by different pathophysiological mechanisms, laboratory findings, imaging features, and therapeutic approaches. Conversely, advanced liver disease may be associated with impaired cardiovascular function, including cirrhotic cardiomyopathy, a condition that frequently remains clinically silent until physiological or therapeutic stress unmasks impaired cardiac reserve. Recent advances in multimodal imaging, including echocardiography with myocardial deformation analysis, abdominal ultrasonography with Doppler evaluation, elastography, computed tomography, and cardiac magnetic resonance, together with emerging biomarkers, have provided additional tools for the recognition and characterization of these disorders, although the clinical value of some newer techniques and biomarkers remains under investigation. Nevertheless, differentiating congestion-related liver injury from progressive fibrosis and identifying subclinical cardiac dysfunction remain important clinical challenges. A comprehensive understanding of the bidirectional interactions between the heart and liver is important for timely diagnosis, accurate risk stratification, and appropriate management. Future studies should focus on standardized diagnostic pathways, validation of novel imaging techniques and biomarkers, and multidisciplinary strategies that may improve outcomes in patients with complex cardiohepatic disease.
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BibTeX
@article{popovic2026heartliver,
title = {{Heart-Liver Interactions: Pathophysiology and Diagnosis of Hypoxic Hepatitis, Congestive Hepatopathy, and Cirrhotic Cardiomyopathy.}},
author = {Dusan Popovic and Nikola Blagojevic and Sanja Dragasevic Vucicevic and Milica Dragovic and Dragana Blagojevic and Tijana Glisic and Dragana Mijac and Milica Stojkovic-Lalosevic and Branka Filipovic and Jelena Bogdanovic and Ljiljana Bogdanovic and Natasa Nikolic and Marija Stojanovic},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193126},
url = {https://europepmc.org/article/MED/42882281},
note = {CC BY},
}
RIS
TY - JOUR
TI - Heart-Liver Interactions: Pathophysiology and Diagnosis of Hypoxic Hepatitis, Congestive Hepatopathy, and Cirrhotic Cardiomyopathy.
AU - Dusan Popovic
AU - Nikola Blagojevic
AU - Sanja Dragasevic Vucicevic
AU - Milica Dragovic
AU - Dragana Blagojevic
AU - Tijana Glisic
AU - Dragana Mijac
AU - Milica Stojkovic-Lalosevic
AU - Branka Filipovic
AU - Jelena Bogdanovic
AU - Ljiljana Bogdanovic
AU - Natasa Nikolic
AU - Marija Stojanovic
PY - 2026
DA - 2026/09/26
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193126
UR - https://europepmc.org/article/MED/42882281
AB - The heart and liver are closely interconnected through complex hemodynamic, neurohumoral, inflammatory, and metabolic mechanisms. Dysfunction of either organ may adversely affect the other, giving rise to a broad spectrum of cardiohepatic disorders with important diagnostic and prognostic implications. This narrative review is based on a literature search strategy of PubMed and the Web of Science Core Collection covering publications from January 2000 through June 2026, with a focus on hypoxic hepatitis, congestive hepatopathy, and cirrhotic cardiomyopathy. Cardiac diseases may induce liver injury through acute hypoperfusion or chronic venous congestion, resulting in distinct clinical entities characterized by different pathophysiological mechanisms, laboratory findings, imaging features, and therapeutic approaches. Conversely, advanced liver disease may be associated with impaired cardiovascular function, including cirrhotic cardiomyopathy, a condition that frequently remains clinically silent until physiological or therapeutic stress unmasks impaired cardiac reserve. Recent advances in multimodal imaging, including echocardiography with myocardial deformation analysis, abdominal ultrasonography with Doppler evaluation, elastography, computed tomography, and cardiac magnetic resonance, together with emerging biomarkers, have provided additional tools for the recognition and characterization of these disorders, although the clinical value of some newer techniques and biomarkers remains under investigation. Nevertheless, differentiating congestion-related liver injury from progressive fibrosis and identifying subclinical cardiac dysfunction remain important clinical challenges. A comprehensive understanding of the bidirectional interactions between the heart and liver is important for timely diagnosis, accurate risk stratification, and appropriate management. Future studies should focus on standardized diagnostic pathways, validation of novel imaging techniques and biomarkers, and multidisciplinary strategies that may improve outcomes in patients with complex cardiohepatic disease.
SN - 2075-4418
ER -