Ultrasound-based assessment of cardiac and hepatic dysfunction: current status and future directions

Heart failure (HF) is a systemic syndrome in which venous congestion and impaired perfusion can produce clinically important hepatic dysfunction. The term cardiohepatic syndrome (CHS) describes this bidirectional interaction, but cardiac and hepatic abnormalities are still often evaluated in parallel rather than as a connected hemodynamic process. Ultrasound is uniquely suited to an integrated assessment because it can characterize cardiac structure and function, systemic venous congestion, hepatic hemodynamics, tissue stiffness, and treatment-related change at the bedside. Conventional transthoracic echocardiography remains the foundation of evaluation, while three-dimensional echocardiography and speckle-tracking techniques improve quantification of right ventricular, atrial, and subclinical myocardial dysfunction. Abdominal Doppler ultrasound, venous congestion scoring, and liver elastography add complementary information, although liver stiffness must be interpreted cautiously because congestion, inflammation, cholestasis, and fibrosis can produce overlapping signals. Artificial intelligence may improve acquisition, measurement reproducibility, and multimodal data integration, but external validation and transparent reporting remain essential. This review summarizes contemporary evidence and proposes a practical, sequential pathway that combines echocardiography, venous Doppler findings, liver stiffness, laboratory biomarkers, and dynamic reassessment after decongestion. The central clinical principle is that CHS should be evaluated as a time-varying cardiohepatic phenotype rather than diagnosed from a single cardiac, hepatic, or biochemical measurement. Integrated ultrasound assessment of cardiohepatic syndrome. Heart failure produces a continuum from myocardial dysfunction and elevated filling pressures to systemic venous congestion, hepatic sinusoidal stress, and potentially fibrosis. A combined protocol uses echocardiography to define the cardiac substrate, venous Doppler ultrasound to quantify pressure transmission, and liver elastography plus biomarkers to characterize hepatic injury. Dynamic reassessment after decongestion helps distinguish reversible congestion from persistent structural liver disease and supports risk-adapted management.