Key result
Optimization of cardiac function frequently improves liver biochemical abnormalities in non-Fontan congestive hepatopathy, though histologic reversibility of fibrosis remains variable.
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Why the study?
Assessing liver disease severity and predicting hepatic outcomes in non-Fontan heart failure is challenging due to the limited diagnostic accuracy of standard biochemical, imaging, and histologic tools, coupled with variable histologic reversibility.
In non-Fontan heart failure, standard diagnostic modalities have limited accuracy for assessing congestive hepatopathy, and while cardiac optimization often improves liver biochemistries, histologic fibrosis reversibility remains variable.
Cardiac optimization may normalize liver biochemistries in non-Fontan hepatopathy; leaves open histologic reversibility and need for better diagnostics.
Hepatic abnormalities in non-Fontan heart failure result from congestive hepatopathy and hypoperfusion-related ischemic injury, compounded by neurohormonal activation and systemic inflammation. Assessment of liver disease severity is challenging because standard liver biochemistries, serum fibrosis markers, severity score models, elastography, and imaging modalities have limited diagnostic accuracy in congestive hepatopathy, and hepatic fibrosis is often heterogeneous on histology in this population. Management focuses on optimization of cardiac function through medical therapy or mechanical circulatory support. Although liver biochemical abnormalities frequently improve with restoration of cardiac function, histologic reversibility is variable and not consistently observed. In patients with advanced heart failure needing heart transplantation, histologic cirrhosis and/or fibrosis accompanied by portal hypertension may merit consideration of combined heart-liver transplantation, but correlation between fibrosis and clinical outcomes varies. There remains an unmet need for tests that can reliably assess liver disease severity and predict liver outcomes in non-Fontan congestive hepatopathy.
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Sack et al. (2026) conducted a review in Hepatic abnormalities and congestive hepatopathy in non-Fontan heart failure. Optimization of cardiac function frequently improves liver biochemical abnormalities in non-Fontan congestive hepatopathy, though histologic reversibility of fibrosis remains variable.
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