Focusing on Cardio-Hepatic Syndrome in Heart Failure and Cardiovascular Interventions: Time to Update the Prognostic Risk Scores?

H eart failure (HF) is a multifactorial, heterogeneous disease characterized by congestion and/or reduced cardiac output, leading to unmet metabolic demands of vital organs. Regardless of the etiology or phenotypic features (ischemic vs. non-ischemic, reduced or preserved ejection fraction, severe valvular stenosis or regurgitation), the “inevitable consequence” of the HF syndrome is the progressive end-organ dysfunction. Failure of one or more organ systems (heart itself, lungs, kidneys, liver, intestine, brain, skeletal muscle) has been the main determinant of survival in HF. 1,2 Integration of new pharmacologic agents (saqubitril/valsartan, sodium-glucose cotransporter-2 (SGLT-2) inhibitors) into guideline-directed medical therapy and advancements in interventional and surgical procedures (complex coronary interventions, transcatheter aortic valve implantation (TAVI), Mitra-clip, left ventricular assist devices) have led to a significant improvement in HF mortality in selected patients. 3-7 However, HF still remains a global health problem associated with reduced survival, frequent hospitalizations, and impaired quality of life.