Limits...
Predictors of cardiac hepatopathy in patients with right heart failure.

Megalla S, Holtzman D, Aronow WS, Nazari R, Korenfeld S, Schwarcz A, Goldberg Y, Spevack DM - Med. Sci. Monit. (2011)

Bottom Line: On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH.Low cardiac output was associated with CH only amongst those without LHF.CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

ABSTRACT

Background: Some patients with right heart failure develop cardiac hepatopathy (CH). The pathophysiology of CH is thought to be secondary to hepatic venous congestion and arterial ischemia. We sought to define the clinical and hemodynamic characteristics associated with CH.

Material/methods: A retrospective cross sectional analysis was performed in which subjects were identified from our institutional cardiology database if echocardiography showed either right ventricular (RV) hypokinesis or dilatation, and was performed within 30 days of right heart catheterization. A chart review was then performed to identify patient clinical characteristics and to determine if the patients had underlying liver disease. Subjects with non-cardiac causes for hepatopathy were excluded.

Results: In 188 included subjects, etiology for right heart dysfunction included left heart failure (LHF), shunt, pulmonary hypertension, mitral- tricuspid- and pulmonic valvular disease. On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH. Low cardiac output was associated with CH only amongst those without LHF.

Conclusions: CH is most often seen in subjects with elevated RV diastolic pressure suggesting a congestive cause in most cases. CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

Show MeSH

Related in: MedlinePlus

Inclusions and exclusions.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3539469&req=5

f1-medscimonit-17-10-cr537: Inclusions and exclusions.

Mentions: A retrospective cross sectional analysis was performed. Our hospital cardiology database was queried to identify all subjects who had right ventricular (RV) hypokinesis or dilatation on echocardiography. Patients were included if they also had right heart catheterization performed within 30 days of their echocardiograms. Charts were reviewed for demographic data, comorbid conditions, medications and serologic assessment of hepatic function. Subjects were excluded from analysis if potential causes of hepatic dysfunction other than cardiac disease were identified on chart review (Figure 1). Subjects with acute shock were excluded, namely those patients who presented with hypotension and/or cardiac arrest. Thereby, this excluded severe acute RV dysfunction and acute left ventricular (LV) dysfunction. Furthermore, subjects with malignancy, autoimmune disease, complex congenital cardiac disease, human immunodeficiency virus, substance abuse, and hemochromatosis were also excluded and labeled as other in Figure 1. These subjects were excluded because of the higher likelihood of noncardiac causes of hepatic dysfunction.


Predictors of cardiac hepatopathy in patients with right heart failure.

Megalla S, Holtzman D, Aronow WS, Nazari R, Korenfeld S, Schwarcz A, Goldberg Y, Spevack DM - Med. Sci. Monit. (2011)

Inclusions and exclusions.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539469&req=5

f1-medscimonit-17-10-cr537: Inclusions and exclusions.
Mentions: A retrospective cross sectional analysis was performed. Our hospital cardiology database was queried to identify all subjects who had right ventricular (RV) hypokinesis or dilatation on echocardiography. Patients were included if they also had right heart catheterization performed within 30 days of their echocardiograms. Charts were reviewed for demographic data, comorbid conditions, medications and serologic assessment of hepatic function. Subjects were excluded from analysis if potential causes of hepatic dysfunction other than cardiac disease were identified on chart review (Figure 1). Subjects with acute shock were excluded, namely those patients who presented with hypotension and/or cardiac arrest. Thereby, this excluded severe acute RV dysfunction and acute left ventricular (LV) dysfunction. Furthermore, subjects with malignancy, autoimmune disease, complex congenital cardiac disease, human immunodeficiency virus, substance abuse, and hemochromatosis were also excluded and labeled as other in Figure 1. These subjects were excluded because of the higher likelihood of noncardiac causes of hepatic dysfunction.

Bottom Line: On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH.Low cardiac output was associated with CH only amongst those without LHF.CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

ABSTRACT

Background: Some patients with right heart failure develop cardiac hepatopathy (CH). The pathophysiology of CH is thought to be secondary to hepatic venous congestion and arterial ischemia. We sought to define the clinical and hemodynamic characteristics associated with CH.

Material/methods: A retrospective cross sectional analysis was performed in which subjects were identified from our institutional cardiology database if echocardiography showed either right ventricular (RV) hypokinesis or dilatation, and was performed within 30 days of right heart catheterization. A chart review was then performed to identify patient clinical characteristics and to determine if the patients had underlying liver disease. Subjects with non-cardiac causes for hepatopathy were excluded.

Results: In 188 included subjects, etiology for right heart dysfunction included left heart failure (LHF), shunt, pulmonary hypertension, mitral- tricuspid- and pulmonic valvular disease. On multivariate analysis, higher RV diastolic pressure and etiology for RV dysfunction other than LHF were both associated with CH. Low cardiac output was associated with CH only amongst those without LHF.

Conclusions: CH is most often seen in subjects with elevated RV diastolic pressure suggesting a congestive cause in most cases. CH associated with low cardiac output in patients without LHF suggests that low flow may be contributing to the patophysiology in some cases.

Show MeSH
Related in: MedlinePlus