The Cardiohepatic Axis in Heart Failure

Cardiogenic liver disease is a sequela of hepatic congestion from right heart failure that leads to hepatic dysfunction and adverse liver remodeling. Understanding the mechanisms and consequences of liver pathology in the syndrome of heart failure is an important unmet need in the care of patients with chronic heart failure. Liver congestion provokes profound responses in hepatocytes and nonparenchymal cells including endothelial cells, macrophages, and hepatic stellate cells. However, the pathways that drive liver fibrosis and dysfunction are poorly understood. Recent human and preclinical data has begun to unravel the cellular landscape and molecular pathways that define cardiogenic liver disease. This review aims to discuss our current understanding of the cardiohepatic axis in heart failure while also highlighting knowledge gaps and opportunities for future investigation.