Boiling Beneath the Surface: Identifying a Recognition Gap in Cardiogenic Liver Disease.

BACKGROUND: Cardiogenic liver disease (CLD) is a common complication in patients with hepatic congestion. However, routine assessment strategies remain poorly defined, and awareness of how to monitor liver involvement with disease progression remains inadequate. PROJECT RATIONALE: We sought to examine whether commonly used liver tests reflect fibrosis burden in CLD. PROJECT SUMMARY: We evaluated patients with heart disease and hepatic congestion, including those with right heart failure or Fontan circulation. Liver fibrosis was assessed and compared with routine liver tests and fibrosis scores at the time of biopsies. Many patients showed relatively modest lab abnormalities and there was a poor correlation between conventional laboratory markers and the extent of hepatic fibrosis. These findings highlight limitations of current assessment strategies and identify a recognition gap in clinical practice. We have proposed a conceptual workflow to improve recognition and risk stratification of CLD. TAKE-HOME MESSAGES: Routine liver tests may underestimate clinically significant CLD. Greater awareness, comprehensive evaluation of high-risk patients including liberal use of liver biopsy, and continued research to develop improved noninvasive diagnostic approaches are needed to enhance disease detection and risk stratification.