循環器ジャーナル68巻1号

2020年01月発行

特集 U40世代が描く心不全診療の現状と未来—基礎研究を識り，臨床を素心深考する Ⅲ．臓器関連

—臨床編—肝疾患が心不全に及ぼす影響と病態はどのようなものですか？

著者： 齋藤佑記¹

所属機関： ¹日本大学医学部内科学系循環器内科学分野

ページ範囲：P.146 - P.151

Point
・心不全に続発する肝機能障害として，「うっ血性肝障害」と「虚血性肝障害」の2つの病態がある．
・非アルコール性脂肪性肝疾患などの肝疾患による肝障害は，心筋リモデリングや心機能障害と関連し，心不全の予後にも関連する．
・血液検査による肝胆道系酵素や肝線維化指標，また超音波エラストグラフィは，心不全の重症度やうっ血の状態を反映し，心不全のリスク層別化に有用な可能性がある．

参考文献

1) Zardi EM, Abbate A, Zardi DM, et al:Cirrhotic cardiomyopathy. J Am Coll Cardiol 56:539-549, 2010

2) Lentine KL, Costa SP, Weir MR, et al:Cardiac disease evaluation and management among kidney and liver transplantation candidates:a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 60:434-480, 2012

3) Goland S, Shimoni S, Zornitzki T, et al:Cardiac abnormalities as a new manifestation of nonalcoholic fatty liver disease:echocardiographic and tissue Doppler imaging assessment. J Clin Gastroenterol 40:949-955, 2006

4) van Deursen VM, Damman K, Hillege HL, et al:Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 16:84-90, 2010

5) Nikolaou M, Parissis J, Yilmaz MB, et al:Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 34:742-749, 2013

6) Nikolaou M, Parissis J, Yilmaz MB, et al:Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 34:742-749, 2013

7) Nagao K, Tamura A, Morimoto T, et al:Liver fibrogenesis marker, 7S domain of collagen type Ⅳ in patients with acutely decompensated heart failure:Correlates, prognostic value and time course. Int J Cardiol 236:483-487, 2017

8) Taniguchi T, Sakata Y, Ohtani T, et al:Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am J Cardiol 113:552-558, 2014

9) Taniguchi T, Ohtani T, Kioka H, et al:Liver Stiffness Reflecting Right-Sided Filling Pressure Can Predict Adverse Outcomes in Patients With Heart Failure. JACC Cardiovasc Imaging 12:955-964, 2019

10) Saito Y, Kato M, Nagashima K, et al:Prognostic Relevance of Liver Stiffness Assessed by Transient Elastography in Patients With Acute Decompensated Heart Failure. Circ J 82:1822-1829, 2018