Boiling Beneath the Surface
- 1Division of Cardiology, Washington University in St Louis, St Louis, Missouri, USA
- 2Department of Immunology/Pathology, Washington University in St Louis, St Louis, Missouri, USA
Abstract
Background: Cardiogenic liver disease (CLD) is a common complication in patients with hepatic congestion. However, routine assessment strategies remain poorly defined, and awareness of how to monitor liver involvement with disease progression remains inadequate.
Project Rationale: We sought to examine whether commonly used liver tests reflect fibrosis burden in CLD.
Project Summary: We evaluated patients with heart disease and hepatic congestion, including those with right heart failure or Fontan circulation. Liver fibrosis was assessed and compared with routine liver tests and fibrosis scores at the time of biopsies. Many patients showed relatively modest lab abnormalities and there was a poor correlation between conventional laboratory markers and the extent of hepatic fibrosis. These findings highlight limitations of current assessment strategies and identify a recognition gap in clinical practice. We have proposed a conceptual workflow to improve recognition and risk stratification of CLD.
Take-Home Messages: Routine liver tests may underestimate clinically significant CLD. Greater awareness, comprehensive evaluation of high-risk patients including liberal use of liver biopsy, and continued research to develop improved noninvasive diagnostic approaches are needed to enhance disease detection and risk stratification.
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BibTeX
@article{elesawy2026boiling,
title = {{Boiling Beneath the Surface}},
author = {Mahmoud I. Elesawy and Joel D. Schilling},
journal = {JACC Case Reports},
year = {2026},
month = sep,
doi = {10.1016/j.jaccas.2026.109547},
url = {https://doi.org/10.1016/j.jaccas.2026.109547},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Boiling Beneath the Surface
AU - Mahmoud I. Elesawy
AU - Joel D. Schilling
PY - 2026
DA - 2026/09/16
JO - JACC Case Reports
DO - 10.1016/j.jaccas.2026.109547
UR - https://doi.org/10.1016/j.jaccas.2026.109547
AB - Background: Cardiogenic liver disease (CLD) is a common complication in patients with hepatic congestion. However, routine assessment strategies remain poorly defined, and awareness of how to monitor liver involvement with disease progression remains inadequate. Project Rationale: We sought to examine whether commonly used liver tests reflect fibrosis burden in CLD. Project Summary: We evaluated patients with heart disease and hepatic congestion, including those with right heart failure or Fontan circulation. Liver fibrosis was assessed and compared with routine liver tests and fibrosis scores at the time of biopsies. Many patients showed relatively modest lab abnormalities and there was a poor correlation between conventional laboratory markers and the extent of hepatic fibrosis. These findings highlight limitations of current assessment strategies and identify a recognition gap in clinical practice. We have proposed a conceptual workflow to improve recognition and risk stratification of CLD. Take-Home Messages: Routine liver tests may underestimate clinically significant CLD. Greater awareness, comprehensive evaluation of high-risk patients including liberal use of liver biopsy, and continued research to develop improved noninvasive diagnostic approaches are needed to enhance disease detection and risk stratification.
SN - 2666-0849
ER -