Heart–Liver Interactions: Pathophysiology and Diagnosis of Hypoxic Hepatitis, Congestive Hepatopathy, and Cirrhotic Cardiomyopathy

The heart and liver are closely interconnected through complex hemodynamic, neurohumoral, inflammatory, and metabolic mechanisms. Dysfunction of either organ may adversely affect the other, giving rise to a broad spectrum of cardiohepatic disorders with important diagnostic and prognostic implications. This narrative review is based on a literature search strategy of PubMed and the Web of Science Core Collection covering publications from January 2000 through June 2026, with a focus on hypoxic hepatitis, congestive hepatopathy, and cirrhotic cardiomyopathy. Cardiac diseases may induce liver injury through acute hypoperfusion or chronic venous congestion, resulting in distinct clinical entities characterized by different pathophysiological mechanisms, laboratory findings, imaging features, and therapeutic approaches. Conversely, advanced liver disease may be associated with impaired cardiovascular function, including cirrhotic cardiomyopathy, a condition that frequently remains clinically silent until physiological or therapeutic stress unmasks impaired cardiac reserve. Recent advances in multimodal imaging, including echocardiography with myocardial deformation analysis, abdominal ultrasonography with Doppler evaluation, elastography, computed tomography, and cardiac magnetic resonance, together with emerging biomarkers, have provided additional tools for the recognition and characterization of these disorders, although the clinical value of some newer techniques and biomarkers remains under investigation. Nevertheless, differentiating congestion-related liver injury from progressive fibrosis and identifying subclinical cardiac dysfunction remain important clinical challenges. A comprehensive understanding of the bidirectional interactions between the heart and liver is important for timely diagnosis, accurate risk stratification, and appropriate management. Future studies should focus on standardized diagnostic pathways, validation of novel imaging techniques and biomarkers, and multidisciplinary strategies that may improve outcomes in patients with complex cardiohepatic disease.