Cumulative mean pulmonary artery pressure as a marker of hepatic congestion in patients with chronic heart failure.
Refinessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries', 2017
Decision at stakethe clinical decision to pursue cardiac workup for congestive hepatopathy
When LFT abnormalities (either cholestatic-pattern with relatively spared transaminases or acute hepatocellular injury) occur alongside elevated right-sided filling pressures, pericardial disease, or systemic congestion, pursue cardiac workup (echocardiogram, BNP/NT-proBNP, hepatic venous Doppler, cardiac MRI or right heart catheterization if equivocal) and treat the underlying cardiac/pericardial driver, pericardiectomy for constriction, volume management for right heart failure, valve surgery for severe TR, HF GDMT. …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
When LFT abnormalities (either cholestatic-pattern with relatively spared transaminases or acute hepatocellular injury) occur alongside elevated right-sided filling pressures, pericardial disease, or systemic congestion, pursue cardiac workup (echocardiogram, BNP/NT-proBNP, hepatic venous Doppler, cardiac MRI or right heart catheterization if equivocal) and treat the underlying cardiac/pericardial driver, pericardiectomy for constriction, volume management for right heart failure, valve surgery for severe TR, HF GDMT. Defer the cirrhosis SOC pathway (NSBB initiation, HCC screen intensification, transplant workup) until cardiac evaluation completes, since congestion-driven liver findings often improve with treatment of the cardiac cause and elastography is falsely elevated in a congested liver. Monitor LFTs during diuresis and reserve liver biopsy for cases where etiology remains unclear after cardiac workup.