Ultrasound-based assessment of cardiac and hepatic dysfunction: current status and future directions.
5 affiliations
- 1Ultrasonography Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 200241, No. 68, Ronglian Road, Malu Town, Jiading District, Shanghai, 200241, China.
- 2Medical Imaging Department, Shanghai Jing 'an District Hospital of Traditional Chinese Medicine, No. 288, Lingjian Middle Road, Shanghai, China.
- 3Emergency and Critical Care Medicine Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200241, China.
- 4Cardiology Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200241, China. [email protected].
- 5Ultrasonography Department, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 200241, No. 68, Ronglian Road, Malu Town, Jiading District, Shanghai, 200241, China. [email protected].
Abstract
Heart failure (HF) is a systemic syndrome in which venous congestion and impaired perfusion can produce clinically important hepatic dysfunction. The term cardiohepatic syndrome (CHS) describes this bidirectional interaction, but cardiac and hepatic abnormalities are still often evaluated in parallel rather than as a connected hemodynamic process. Ultrasound is uniquely suited to an integrated assessment because it can characterize cardiac structure and function, systemic venous congestion, hepatic hemodynamics, tissue stiffness, and treatment-related change at the bedside. Conventional transthoracic echocardiography remains the foundation of evaluation, while three-dimensional echocardiography and speckle-tracking techniques improve quantification of right ventricular, atrial, and subclinical myocardial dysfunction. Abdominal Doppler ultrasound, venous congestion scoring, and liver elastography add complementary information, although liver stiffness must be interpreted cautiously because congestion, inflammation, cholestasis, and fibrosis can produce overlapping signals. Artificial intelligence may improve acquisition, measurement reproducibility, and multimodal data integration, but external validation and transparent reporting remain essential. This review summarizes contemporary evidence and proposes a practical, sequential pathway that combines echocardiography, venous Doppler findings, liver stiffness, laboratory biomarkers, and dynamic reassessment after decongestion. The central clinical principle is that CHS should be evaluated as a time-varying cardiohepatic phenotype rather than diagnosed from a single cardiac, hepatic, or biochemical measurement.
Graphical Abstract: Integrated ultrasound assessment of cardiohepatic syndrome. Heart failure produces a continuum from myocardial dysfunction and elevated filling pressures to systemic venous congestion, hepatic sinusoidal stress, and potentially fibrosis. A combined protocol uses echocardiography to define the cardiac substrate, venous Doppler ultrasound to quantify pressure transmission, and liver elastography plus biomarkers to characterize hepatic injury. Dynamic reassessment after decongestion helps distinguish reversible congestion from persistent structural liver disease and supports risk-adapted management.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12947-026-00389-z.
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BibTeX
@article{li2026ultrasoundbased,
title = {{Ultrasound-based assessment of cardiac and hepatic dysfunction: current status and future directions.}},
author = {Yin-Xia Li and Lei Chen and Peng Chen and Yi-Sheng Wang and Rui Shen},
journal = {Cardiovascular ultrasound},
year = {2026},
month = nov,
doi = {10.1186/s12947-026-00389-z},
url = {https://europepmc.org/article/MED/42968102},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Ultrasound-based assessment of cardiac and hepatic dysfunction: current status and future directions.
AU - Yin-Xia Li
AU - Lei Chen
AU - Peng Chen
AU - Yi-Sheng Wang
AU - Rui Shen
PY - 2026
DA - 2026/11/02
JO - Cardiovascular ultrasound
DO - 10.1186/s12947-026-00389-z
UR - https://europepmc.org/article/MED/42968102
AB - Heart failure (HF) is a systemic syndrome in which venous congestion and impaired perfusion can produce clinically important hepatic dysfunction. The term cardiohepatic syndrome (CHS) describes this bidirectional interaction, but cardiac and hepatic abnormalities are still often evaluated in parallel rather than as a connected hemodynamic process. Ultrasound is uniquely suited to an integrated assessment because it can characterize cardiac structure and function, systemic venous congestion, hepatic hemodynamics, tissue stiffness, and treatment-related change at the bedside. Conventional transthoracic echocardiography remains the foundation of evaluation, while three-dimensional echocardiography and speckle-tracking techniques improve quantification of right ventricular, atrial, and subclinical myocardial dysfunction. Abdominal Doppler ultrasound, venous congestion scoring, and liver elastography add complementary information, although liver stiffness must be interpreted cautiously because congestion, inflammation, cholestasis, and fibrosis can produce overlapping signals. Artificial intelligence may improve acquisition, measurement reproducibility, and multimodal data integration, but external validation and transparent reporting remain essential. This review summarizes contemporary evidence and proposes a practical, sequential pathway that combines echocardiography, venous Doppler findings, liver stiffness, laboratory biomarkers, and dynamic reassessment after decongestion. The central clinical principle is that CHS should be evaluated as a time-varying cardiohepatic phenotype rather than diagnosed from a single cardiac, hepatic, or biochemical measurement. Graphical Abstract: Integrated ultrasound assessment of cardiohepatic syndrome. Heart failure produces a continuum from myocardial dysfunction and elevated filling pressures to systemic venous congestion, hepatic sinusoidal stress, and potentially fibrosis. A combined protocol uses echocardiography to define the cardiac substrate, venous Doppler ultrasound to quantify pressure transmission, and liver elastography plus biomarkers to characterize hepatic injury. Dynamic reassessment after decongestion helps distinguish reversible congestion from persistent structural liver disease and supports risk-adapted management. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12947-026-00389-z.
SN - 1476-7120
ER -