title: Predictors of cardiac hepatopathy in patients with right heart failure.
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.
  
  
  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.
authors.affiliation: Department of Medicine, Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Sherry
authors.initials: S
authors.lastname: Megalla
authors.forename: Dvorah
authors.initials: D
authors.lastname: Holtzman
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Reza
authors.initials: R
authors.lastname: Nazari
authors.forename: Svetlana
authors.initials: S
authors.lastname: Korenfeld
authors.forename: Aron
authors.initials: A
authors.lastname: Schwarcz
authors.forename: Ythan
authors.initials: Y
authors.lastname: Goldberg
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Spevack
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000209:etiology*; D006349:Heart Valve Diseases / Q000150:complications; D006801:Humans; D006973:Hypertension; D006976:Hypertension, Pulmonary / Q000150:complications; D008107:Liver Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin