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Cardio-Hepatology

Connections Between Hepatic and Cardiovascular Disease

BY

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Samuel S. Lee

Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Table of Contents

Cover image

Title page

Copyright

Dedication

List of contributors

Preface

Part I: Liver and heart

Chapter 1. The liver–heart relationship: a history

Abstract

Introduction

The ancient world: east and west

The medieval era

The modern era

References

Chapter 2. Nonalcoholic fay liver disease and cardiovascular disease

Abstract

Introduction

The definition of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Association between nonalcoholic fatty liver disease/nonalcoholic steatohepatitis and cardiovascular disease

Dyslipidemia as causative factors for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis and cardiovascular disease

Possible underlining molecular mechanisms between nonalcoholic steatohepatitis and atherosclerosis

Association between NAFLD/hepatic fibrosis and cardiac dysfunction

Conclusion

References

Chapter 3. Pathophysiologic changes in chronic heart failure affecting drug pharmacokinetics

Abstract

Introduction

Fundamental clinical pharmacokinetic principles

Pathophysiological changes affecting pharmacokinetics in patients with chronic heart failure

Pharmacotherapeutic implications: general recommendations

Conclusion

References

Chapter 4. Drugs at the crossroads of heart and liver

Abstract

Introduction

Part 1: amiodarone

Part 2: beta-blockers

The concept of a therapeutic window of nonselective betablockers in decompensated cirrhosis

Summary and current recommendations

References

Chapter 5. Obstruction of the liver circulation

Abstract

Introduction

Budd–Chiari syndrome

Risk factors

Natural history

Staging and prognosis

Treatment and management of complications

Noncirrhotic nontumoral portal vein thrombosis

Risk factors

Diagnosis and staging

Natural history

Treatment of recent nontumoral portal vein thrombosis

Treatment of chronic nontumoral portal vein thrombosis

Sinusoidal obstruction syndrome

Diagnosis

Preventive measures

Treatment

Hepatic artery thrombosis

Etiology and risk factors

Clinical presentation

Treatment

Acknowledgment

Conflict of interest statement

Financial support

References

Part II: Hepatobiliary system in heart failure

Chapter 6. Epidemiology of liver diseases in heart failure

Abstract

Introduction

The liver diseases in patients with heart failure

Diseases leading to heart failure and affecting the liver

References

Chapter 7. Cardio-hepatology: liver function tests in heart failure

Abstract

Liver function tests

Blood supply of the liver and its anatomy

Pathophysiology of abnormal liver function tests in heart failure

Bilirubin metabolism in the liver

Association between abnormal liver function tests and impaired hemodynamics

Liver function tests and prognosis in heart failure

References

Chapter 8. Prognostic value of liver assessment (including liver stiffness measurement) in cardiovascular diseases

Abstract

Introduction

Heart failure and liver impairment

Liver disease is associated with poor outcome of heart failure

Liver disease is associated with poor outcomes of cardiovascular diseases

Liver function tests and prognosis of HF

Markers of hepatic fibrosis and prognosis of HF

Imaging markers of hepatic fibrosis in HF

Summary

References

Chapter 9. Passive liver congestion and hypoxic hepatitis

Abstract

Introduction

Passive liver congestion

Conclusion

References

Chapter 10. Histopathology of the liver in heart failure

Abstract

Introduction

Natural history

Pathological analysis

Pathogenesis

Conclusion

References

Chapter 11. The Fontan procedure and liver disease

Abstract

Introduction

Fontan procedure

Physiology and prevalence of Fontan-associated liver disease

Examination to detect Fontan-associated liver disease

Recommendation

References

Part III: Cardiovascular system in liver failure

Chapter 12. Sepsis and the liver

Abstract

Introduction

Sepsis in the general population

Sepsis in patients with cirrhosis

Conclusions

Acknowledgments

References

Chapter 13. Bleeding and thrombosis in cirrhosis

Abstract

Introduction to hemostasis

Hemostatic changes in liver diseases

Pitfalls of routine diagnostic tests of hemostasis

The concept of rebalanced hemostasis

Hemostatic balance in different types and severities of liver diseases

Bleeding in liver diseases

Thrombosis in liver diseases

Intrahepatic thrombosis and disease progression

Hemostasis and liver regeneration

Conclusion

References

Chapter 14. Peripheral vasculature in portal hypertension

Abstract

Introduction

Hyperdynamic circulation

Increased blood and plasma volume/decreased effective circulating volume

Peripheral venous “sump” effect due to venous pooling

Abnormalities of arterial vascular tone

Nervous system and peripheral vascular changes

Management of hyperdynamic circulation

Conclusions

References

Chapter 15. Cirrhotic cardiomyopathy

Abstract

Introduction

Definition and diagnostic criteria

Clinical significance

Morbidity/mortality after cardiovascular challenges

Cirrhotic cardiomyopathy and prognosis

Pathogenic mechanisms

TNFα

β-Adrenergic signaling

Membrane fluidity

Bile acids

Nitric oxide

Carbon monoxide

Myosin heavy chain isoform shift

The role of ion channels in cirrhotic cardiomyopathy

Titin and collagen isoforms

Endocannabinoids

Management

Liver transplantation

Conclusion

References

Chapter 16. Cardiovascular dysfunction in liver diseases: pediatric perspectives

Abstract

Introduction

Cardiovascular consequences of structural congenital heart diseases coexisting with diseases of the liver

Cardiovascular complications of pediatric cirrhosis

Mechanistic insights into bile acid-myocardial interaction

Cardiovascular consequences of inherited metabolic liver failure and failure of energy metabolism

Cardiovascular consequences of acute liver failure

Cardiovascular consequences of chronic cirrhosis, portal hypertension, and portosystemic shunts

Cardiovascular consequences of immunotherapy used in liver transplants

Evaluation of the cardiovascular status before liver transplantation

Future directions and opportunities for research

References

Chapter 17. Hepatorenal syndrome and acute kidney injury in cirrhosis

Abstract

Introduction

The evolving concept of renal dysfunction in cirrhosis

Definition and diagnostic criteria of acute kidney injury in cirrhosis

Epidemiology

Pathophysiology

Hemodynamic changes in cirrhosis

Cardiac dysfunction in cirrhosis

The role of inflammation

Predictive factors for the development of hepatorenal syndromeacute kidney injury

Diagnosis

Biomarkers

Management

General measures

Albumin

Vasoconstrictors

Renal replacement therapy

Liver transplantation

Combined liver kidney transplant

Prognosis

Prevention

Conclusion

References

Chapter 18. Cardiopulmonary considerations for the anesthetic management of liver transplantation

Abstract

Perioperative cardiovascular management in the liver transplant patient

Perioperative pulmonary management in the liver transplant recipient

References

Chapter 19. Cardiovascular assessment before liver transplantation

Abstract

Introduction

References

Chapter 20. Predicting cardiovascular complications after liver transplantation

Abstract

Introduction

Epidemiology and established risk factors for cardiovascular complications in liver transplantation

Natural history and timing of cardiovascular events in liver transplantation

Algorithms and risk calculators for prediction of cardiovascular risk after liver transplantation

Conclusions

References

Copyright

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

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Dedication

To my parents, wife, and children.

To my proudest legacy, my sons Simon, Jack, and Eric.

List of contributors

Juan Gonzalez Abraldes, Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada

Mario Altieri, Service d’Hépato-Gastroentérologie et Nutrition, Unité de Transplantation Hépatique, Centre Hospitalier Universitaire, Caen, France

Vicente Arroyo, EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain

Dina Aia, Gastroenterology, Hepatology and Endemic Diseases Departments, Beni Suef University, Beni Suef, Egypt

Anna Baiges, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Soon Koo Baik

Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea

Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea

Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Korea

Fabian Betancourt, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques

August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Ryan Chadha, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, United States

Daljeet Chahal, University of British Columbia, Vancouver, BC, Canada

Po-Hung Chen, Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Moreshwar S. Desai, Pediatric Liver Intensive Care, Department of Pediatrics, Division of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States

Iliana Doycheva, Division of Gastroenterology & Hepatology, The Mayo Clinic, Rochester, MN, United States

Javier Fernandez

EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain

Liver Unit, Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain

Yasser Fouad, Gastroenterology, Hepatology and Endemic Diseases Departments, Minia University, Minia, Egypt

Juan Carlos García-Pagán, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Madrid, Spain

Noelle Gorgis, Pediatric Liver Intensive Care, Department of Pediatrics, Division of Pediatric Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States

Harini Gurram, Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University

Feinberg School of Medicine, Chicago, IL, United States

Virginia Hernández-Gea, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions

Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Invetsigación

Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Madrid, Spain

Shaz Iqbal, Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Manhal Izzy, Division of Gastroenterology, Hepatology, and Nutritions, Vanderbilt University, Nashville, TN, United States

Jennifer Jo, Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University

Feinberg School of Medicine, Chicago, IL, United States

Seong Hee Kang

Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea

Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea

Cell Therapy and Tissue Engineering Center, Yonsei University

Wonju College of Medicine, Wonju, Korea

Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea

Rofida Khalifa, Gastroenterology, Hepatology and Endemic Diseases Departments, Minia University, Minia, Egypt

Masahiro Koseki, Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Masanari Kuwabara

Department of Cardiology, Toranomon Hospital, Minato, Tokyo, Japan

Department of Cardiology, Cardiovascular Center, St. Luke’s International Hospital, Chuo, Tokyo, Japan

Samuel S. Lee, Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Ton Lisman, Surgical Research Laboratory, Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Hongqun Liu, Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Xuefeng Luo, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August

Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Marta Magaz, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August

Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Vladimir Marquez, University of British Columbia, Vancouver, BC, Canada

Richard Moreau

EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain

INSERM et Université de Paris, Centre de Recherche sur l’Inflammation (CRI), Paris, France

Service d’Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France

Oana Nicoar-Farcu, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques

August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Koichiro Niwa, Department of Cardiology, Cardiovascular Center, St. Luke’s International Hospital, Chuo, Tokyo, Japan

Atsushi Okada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

P. Timothy Pollak, Department of Medicine and Cardiac Sciences, Amiodarone Monitoring Clinic, University of Calgary, Calgary, AB, Canada

Yuki Saito, Department of Cardiology, Nihon University School of Medicine, Itabashi, Tokyo, Japan

Bonifasius S. Singu, School of Pharmacy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia

Guillem Soy, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Tatsunori Taniguchi, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Fanny Turon, Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Invetsigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Universidad de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERNLiver), Madrid, Spain

Paradis Valérie, Pathology Department, Beaujon Hospital, Paris University, Paris, France

Lisa B. VanWagner

Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Roger K. Verbeeck, School of Pharmacy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia

Kymberly D. Wa, Division of Gastroenterology & Hepatology, The Mayo Clinic, Rochester, MN, United States

Florence Wong, Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto General Hospital, Toronto, ON, Canada

Christopher L. Wray, Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA, United States

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