Heart and bile acids – Clinical consequences of altered bile acid metabolism

https://doi.org/10.1016/j.bbadis.2017.12.039Get rights and content
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Highlights

  • Studies show that elevated serum bile acids are associated with cardiac dysfunction

  • Bile acids have been implicated in the formation of cirrhotic cardiomyopathy

  • Bile acids with a higher hydrophobicity have an increased dysfunctional effect

Abstract

Cardiac dysfunction has an increased prevalence in diseases complicated by liver cirrhosis such as primary biliary cholangitis and primary sclerosing cholangitis. This observation has led to research into the association between abnormalities in bile acid metabolism and cardiac pathology. Approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy. Bile acids are directly implicated in this, causing QT interval prolongation, cardiac hypertrophy, cardiomyocyte apoptosis and abnormal haemodynamics of the heart. Elevated maternal serum bile acids in intrahepatic cholestasis of pregnancy, a disorder which causes an impaired feto-maternal bile acid gradient, have been associated with fatal fetal arrhythmias. The hydrophobicity of individual bile acids in the serum bile acid pool is of relevance, with relatively lipophilic bile acids having a more harmful effect on the heart. Ursodeoxycholic acid can reverse or protect against these detrimental cardiac effects of elevated bile acids.

Keywords

Bile acids
Cirrhotic cardiomyopathy
Intrahepatic cholestasis of pregnancy
Primary biliary cholangitis
Primary sclerosing cholangitis
Ursodeoxycholic acid

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This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni and Peter Jansen.