Although there is an established bidirectional relationship between heart failure with reduced ejection fraction and liver disease, the association between heart failure with preserved ejection fraction (HFpEF) and liver diseases, such as nonalcoholic fatty liver disease (NAFLD), has not been well explored. In this paper, the authors provide an in-depth review of the relationship between HFpEF and NAFLD and propose 3 NAFLD-related HFpEF phenotypes (obstructive HFpEF, metabolic HFpEF, and advanced liver fibrosis HFpEF). The authors also discuss diagnostic challenges related to the concurrent presence of NAFLD and HFpEF and offer several treatment options for NAFLD-related HFpEF phenotypes. The authors propose that NAFLD-related HFpEF should be recognized as a distinct HFpEF phenotype.
Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase; AV, arteriovenous; BCAA, branched-chain amino acid; GLP, glucagon-like peptide; HF, heart failure; HFpEF; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IL, interleukin; LV, left ventricular; LVEF, left ventricular ejection fraction; NAFLD; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NT-proBNP, N terminal pro–B-type natriuretic peptide; RAAS, renin-angiotensin aldosterone system; SGLT2, sodium-glucose cotransporter 2; SPSS, spontaneous portosystemic shunt(s); TNF, tumor necrosis factor; cardiomyopathy; heart failure; liver.
© 2021 The Authors.