title: Gastrointestinal and Liver Issues in Heart Failure.
abstract: Heart failure affects ≈23 million people worldwide and continues to have a high mortality despite advancements in modern pharmacotherapy and device therapy. HF is a complex clinical syndrome that can result in the impairment of endocrine, hematologic, musculoskeletal, renal, respiratory, peripheral vascular, hepatic, and gastrointestinal systems. Although gastrointestinal involvement and hepatic involvement are common in HF and are associated with increased morbidity and mortality, their bidirectional association with HF progression remains poorly fathomed. The current understanding of multiple mechanisms, including proinflammatory cytokine milieu, hormonal imbalance, and anabolic/catabolic imbalance, has been used to explain the relationship between the gut and HF and has been the basis for many novel therapeutic strategies. However, the failure of these novel therapies such as anti-tumor necrosis factor-α has resulted in further complexity. In this review, we describe the involvement of the gastrointestinal and liver systems within the HF syndrome, their pathophysiological mechanisms, and their clinical consequences.
authors.affiliation: From Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (V.S.); and Division of Cardiovascular Medicine, University of Utah Health Science Center, Salt Lake City (J.C.F.).
authors.forename: Varun
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: From Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (V.S.); and Division of Cardiovascular Medicine, University of Utah Health Science Center, Salt Lake City (J.C.F.). james.fang@hsc.utah.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D000818:Animals; D002317:Cardiovascular Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*
chemical_list: D002317:Cardiovascular Agents
keywords: gastrointestinal tract; heart failure