The Cardiohepatic Axis in Cirrhosis

Abstract

Cardiac dysfunction in the setting of cirrhosis is often overlooked despite its impact on contractility, diastolic dysfunction, and electrophysiological abnormalities. This review examines the complex interactions of the cardiohepatic axis, with a particular focus on how liver disease impacts heart function. We highlight the roles of portal hypertension, systemic inflammation, hemodynamic changes, and neurohormonal signaling to shed light on this important connection. The underlying mechanisms for impaired cardiac performance involve both molecular and structural changes. Diagnosis remains challenging because it is frequently subclinical; however, advanced imaging, biomarkers, and electrocardiographic changes have improved early detection. Clinically, this syndrome has significant implications, particularly in decompensated cirrhosis and periods of increased myocardial stress. Although no standardized treatment guidelines exist, orthotopic liver transplantation remains the most effective intervention and often results in cardiovascular recovery. A multidisciplinary approach between cardiologists, hepatologists, and transplant surgeons is crucial to improving patient outcomes and optimizing long-term management.