{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:25:06Z","timestamp":1787502306330,"version":"build-2736575974"},"reference-count":95,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Card Fail Rev"],"abstract":"<jats:p>Acute heart failure (AHF) is a systemic condition characterised by multiorgan involvement that varies from subclinical to overt organ failure. The liver is particularly vulnerable due to its dual blood supply and sensitivity to haemodynamic and inflammatory disturbances. Abnormal liver function tests are highly prevalent in patients with AHF, reflecting major mechanisms: passive hepatic venous congestion from elevated central venous pressure, hepatocellular ischaemia from low cardiac output, systemic inflammation and poor metabolic status associated with cachexia. In patients with AHF, liver function tests at admission, during hospitalisation and at discharge are independently associated with rehospitalisation, cardiovascular and all-cause mortality. Persistent abnormalities after hospitalisation often reflect incomplete decongestion or irreversible structural liver changes. Therapeutic strategies focus on decongestion, optimisation of cardiac output and medication adjustments to avoid hepatotoxicity. Despite significant advances in understanding cardio-hepatic interactions, major gaps remain, including the lack of standardised definitions, limited mechanistic studies and the underrepresentation of patients with heart failure with preserved ejection fraction in contemporary research. Future research should explore targeted therapies to improve cardiohepatic interactions and patient outcomes.<\/jats:p>","DOI":"10.15420\/cfr.2025.51","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:42:00Z","timestamp":1783935720000},"source":"Crossref","is-referenced-by-count":1,"title":["Liver Function Abnormalities in Acute Heart Failure: A State-of-the-art Review from an International Expert Group"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4611-8413","authenticated-orcid":false,"given":"Oliviana","family":"Geavlete","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4563-1071","authenticated-orcid":false,"given":"Andrew P","family":"Ambrosy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-7753","authenticated-orcid":false,"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5641-8332","authenticated-orcid":false,"given":"Sean P","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-7722","authenticated-orcid":false,"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-1815","authenticated-orcid":false,"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9527-0852","authenticated-orcid":false,"given":"John","family":"Teerlink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4023-2263","authenticated-orcid":false,"given":"Giuseppe MC","family":"Rosano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1955-4199","authenticated-orcid":false,"given":"Petar","family":"Seferovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-2877","authenticated-orcid":false,"given":"Razvan I","family":"Radu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2374-6449","authenticated-orcid":false,"given":"Beth","family":"Davison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2744-613X","authenticated-orcid":false,"given":"Alexandru","family":"Ababei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9589-0023","authenticated-orcid":false,"given":"Marija","family":"Polovina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6851-4417","authenticated-orcid":false,"given":"Anika","family":"Naidu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7924-9751","authenticated-orcid":false,"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-943X","authenticated-orcid":false,"given":"Luca","family":"Monzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6235-984X","authenticated-orcid":false,"given":"Alberto","family":"Palazzuoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Radu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1411-4482","authenticated-orcid":false,"given":"Lars H","family":"Lund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6941-1738","authenticated-orcid":false,"given":"Tuvia","family":"Ben Gal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-9213","authenticated-orcid":false,"given":"Maurizio","family":"Volterrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3197-3628","authenticated-orcid":false,"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9613-3339","authenticated-orcid":false,"given":"Gad","family":"Cotter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8683-7044","authenticated-orcid":false,"given":"Mandeep R","family":"Mehra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7683-4720","authenticated-orcid":false,"given":"Javed","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-4260","authenticated-orcid":false,"given":"Andrew JS","family":"Coats","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9069-2722","authenticated-orcid":false,"given":"Vlad","family":"Iliescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Palazzuoli A, Del Buono MG, La Vecchia G, et al. Worsening versus advanced heart failure: management and challenges. ESC Heart Fail 2025;12:3856\u201368. https:\/\/doi.org\/10.1002\/EHF2.15437; PMID:\u00a041045229.","DOI":"10.1002\/ehf2.15437"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Biegus J, Hillege HL, Postmus D, et al. Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study. Eur J Heart Fail 2016;18:830\u20139. https:\/\/doi.org\/10.1002\/ejhf.532; PMID:\u00a027170455.","DOI":"10.1002\/ejhf.532"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Nikolaou M, Parissis J, Yilmaz MB, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 2013;34:742\u20139. https:\/\/doi.org\/10.1093\/eurheartj\/ehs332; PMID:\u00a023091203.","DOI":"10.1093\/eurheartj\/ehs332"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Samsky MD, Dunning A, DeVore AD, et al. Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF. Eur J Heart Fail 2016;18:424\u201332. https:\/\/doi.org\/10.1002\/ejhf.440; PMID:\u00a026707029.","DOI":"10.1002\/ejhf.440"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Biegus J, Demissei B, Postmus D, et al. Hepatorenal dysfunction identifies high-risk patients with acute heart failure: insights from the RELAX-AHF trial. ESC Heart Fail 2019;6:1188\u201398. https:\/\/doi.org\/10.1002\/ehf2.12477; PMID:\u00a031568696.","DOI":"10.1002\/ehf2.12477"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Scholfield M, Schabath MB, Guglin M. Longitudinal trends, hemodynamic profiles, and prognostic value of abnormal liver function tests in patients with acute decompensated heart failure: an analysis of the ESCAPE trial. J Card Fail 2014;20:476\u201384. https:\/\/doi.org\/10.1016\/j.cardfail.2014.05.001; PMID:\u00a024845963.","DOI":"10.1016\/j.cardfail.2014.05.001"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Ambrosy AP, Vaduganathan M, Huffman MD, et al. Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 2012;14:302\u201311. https:\/\/doi.org\/10.1093\/eurjhf\/hfs007; PMID:\u00a022357577.","DOI":"10.1093\/eurjhf\/hfs007"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Chioncel O, Ambrosy AP, Filipescu D, et al. Patterns of intensive care unit admissions in patients hospitalized for heart failure: insights from the RO-AHFS registry. J Cardiovasc Med (Hagerstown) 2015;16:331\u201340. https:\/\/doi.org\/10.2459\/JCM.0000000000000030; PMID:\u00a024710424.","DOI":"10.2459\/JCM.0000000000000030"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Myhre PL, Grupper A, Mebazaa A, et al. Changes in liver function tests, congestion, and prognosis after acute heart failure: the STRONG-HF trial. JACC Adv 2025;4:101607. https:\/\/doi.org\/10.1016\/j.jacadv.2025.101607; PMID:\u00a039983609.","DOI":"10.1016\/j.jacadv.2025.101607"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Allen LA, Felker GM, Pocock S, et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Eur J Heart Fail 2009;11:170\u20137. https:\/\/doi.org\/10.1093\/eurjhf\/hfn031; PMID:\u00a019168515.","DOI":"10.1093\/eurjhf\/hfn031"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Uthamalingam S, Kandala J, Daley M, et al. Serum albumin and mortality in acutely decompensated heart failure. Am Heart J 2010;160:1149\u201355. https:\/\/doi.org\/10.1016\/j.ahj.2010.09.004; PMID:\u00a021146671.","DOI":"10.1016\/j.ahj.2010.09.004"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Van Deursen VM, Edwards C, Cotter G, et al. Liver function, in-hospital, and post-discharge clinical outcome in patients with acute heart failure \u2013 results from the relaxin for the treatment of patients with acute heart failure study. J Card Fail 2014;20:407\u201313. https:\/\/doi.org\/10.1016\/j.cardfail.2014.03.003; PMID:\u00a024642379.","DOI":"10.1016\/j.cardfail.2014.03.003"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Barbiero R, Baccillieri M, Santagata D, et al. Lower albumin levels are associated with 1-year mortality in older patients hospitalized for acute heart failure: the ALBIMED-HF study. Intern Emerg Med 2025;20:805\u201316. https:\/\/doi.org\/10.1007\/s11739-025-03882-x; PMID:\u00a039948326.","DOI":"10.1007\/s11739-025-03882-x"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Rappaport AM. The microcirculatory hepatic unit. Microvasc Res 1973;6:212\u201328. https:\/\/doi.org\/10.1016\/0026-2862(73)90021-6; PMID:\u00a04748021.","DOI":"10.1016\/0026-2862(73)90021-6"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol 2010;16:6046\u201357. https:\/\/doi.org\/10.3748\/wjg.v16.i48.6046; PMID:\u00a021182219.","DOI":"10.3748\/wjg.v16.i48.6046"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"M\u00f8ller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J 2013;34:2804\u201311. https:\/\/doi.org\/10.1093\/eurheartj\/eht246; PMID:\u00a023853073.","DOI":"10.1093\/eurheartj\/eht246"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis 2002;6:947\u201367. https:\/\/doi.org\/10.1016\/S1089-3261(02)00056-9; PMID:\u00a012516201.","DOI":"10.1016\/S1089-3261(02)00056-9"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Seeto RK, Fenn B, Rockey DC. Ischemic hepatitis: clinical presentation and pathogenesis. Am J Med 2000;109:109\u201313. https:\/\/doi.org\/10.1016\/S0002-9343(00)00461-7; PMID:\u00a010967151.","DOI":"10.1016\/S0002-9343(00)00461-7"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Henrion J, Schapira M, Luwaert R, et al. Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases. Medicine (Baltimore) 2003;82:392\u2013406. https:\/\/doi.org\/10.1097\/01.md.0000101573.54295.bd; PMID:\u00a014663289.","DOI":"10.1097\/01.md.0000101573.54295.bd"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Sherlock S. The liver in heart failure; relation of anatomical, functional, and circulatory changes. Br Heart J 1951;13:273\u201393. https:\/\/doi.org\/10.1136\/hrt.13.3.273; PMID:\u00a014848381.","DOI":"10.1136\/hrt.13.3.273"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Viduljevi\u0107 M, Polovina M, Geavlete O, et al. The right approach: power of biomarkers in the assessment and management of right ventricular dysfunction. Int J Mol Sci 2025;26:9064. https:\/\/doi.org\/10.3390\/ijms26189064; PMID:\u00a041009628.","DOI":"10.3390\/ijms26189064"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Auer J. What does the liver tell us about the failing heart? Eur Heart J 2013;34:711\u20134. https:\/\/doi.org\/10.1093\/eurheartj\/ehs440; PMID:\u00a023257947.","DOI":"10.1093\/eurheartj\/ehs440"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Kavoliuniene A, Vaitiekiene A, Cesnaite G. Congestive hepatopathy and hypoxic hepatitis in heart failure: a cardiologist\u2019s point of view. Int J Cardiol 2013;166:554\u20138. https:\/\/doi.org\/10.1016\/j.ijcard.2012.05.003; PMID:\u00a022656043.","DOI":"10.1016\/j.ijcard.2012.05.003"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Monzo L, Jarolim P, Borlaug BA, et al. Growth differentiation factor-15 is associated with congestion-related anorexia and weight loss in advanced heart failure. JACC Heart Fail 2025;13:315\u201329. https:\/\/doi.org\/10.1016\/j.jchf.2024.10.023; PMID:\u00a039797849.","DOI":"10.1016\/j.jchf.2024.10.023"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Orjichukwu CK, Orjichukwu RO, Akpunonu PK, et al. Microbiome and heart failure: a comprehensive review of gut health and microbiota-derived metabolites in heart failure progression. Med Sci (Basel) 2025;13:302. https:\/\/doi.org\/10.3390\/medsci13040302; PMID:\u00a041440534.","DOI":"10.3390\/medsci13040302"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Park AC, Schilling JD. The cardiohepatic axis in heart failure. JACC Basic Transl Sci 2025;10:101312. https:\/\/doi.org\/10.1016\/j.jacbts.2025.05.007; PMID:\u00a040738518.","DOI":"10.1016\/j.jacbts.2025.05.007"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Albillos A, de Gottardi A, Rescigno M. The gut\u2013liver axis in liver disease: pathophysiological basis for therapy. J Hepatol 2020;72:558\u201377. https:\/\/doi.org\/10.1016\/j.jhep.2019.10.003; PMID:\u00a031622696.","DOI":"10.1016\/j.jhep.2019.10.003"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Plaza-D\u00edaz J, Sol\u00eds-Urra P, Rodr\u00edguez-Rodr\u00edguez F, et al. The gut barrier, intestinal microbiota, and liver disease: molecular mechanisms and strategies to manage. Int J Mol Sci 2020;21:8351. https:\/\/doi.org\/10.3390\/ijms21218351; PMID:\u00a033171747.","DOI":"10.3390\/ijms21218351"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Garofalo M, Corso R, Tomasoni D, et al. Inflammation in acute heart failure. Front Cardiovasc Med 2023;10:1235178. https:\/\/doi.org\/10.3389\/fcvm.2023.1235178; PMID:\u00a038045909.","DOI":"10.3389\/fcvm.2023.1235178"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Pizzarossa AC, Rebella M. Hypoxic hepatitis and furosemide. BMJ Case Rep 2018;2018:bcr2018225497. https:\/\/doi.org\/10.1136\/bcr-2018-225497; PMID:\u00a030275022.","DOI":"10.1136\/bcr-2018-225497"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Lang I, Huber K, Capek J, et al. Furosemide and increases in liver enzymes. Ann Intern Med 1988;109:845. https:\/\/doi.org\/10.7326\/0003-4819-109-10-845; PMID:\u00a03190037.","DOI":"10.7326\/0003-4819-109-10-845"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"van Limmen J, Iturriagagoitia X, Verougstraete M, et al. Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study. BMC Anesthesiol 2022;22:202. https:\/\/doi.org\/10.1186\/s12871-022-01741-2; PMID:\u00a035780092.","DOI":"10.1186\/s12871-022-01741-2"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Overgaard CB, D\u017eav\u00edk V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation 2008;118:1047\u201356. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.107.728840; PMID:\u00a018765387.","DOI":"10.1161\/CIRCULATIONAHA.107.728840"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Lewis JH, Ranard RC, Caruso A, et al. Amiodarone hepatotoxicity: prevalence and clinicopathologic correlations among 104 patients. Hepatology 1989;9:679\u201385. https:\/\/doi.org\/10.1002\/hep.1840090504; PMID:\u00a02785079.","DOI":"10.1002\/hep.1840090504"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Grodin JL, Lala A, Stevens SR, et al. Clinical implications of serum albumin levels in acute heart failure: insights from DOSE-AHF and ROSE-AHF. J Card Fail 2016;22:884\u201390. https:\/\/doi.org\/10.1016\/j.cardfail.2016.01.015; PMID:\u00a026844764.","DOI":"10.1016\/j.cardfail.2016.01.015"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Inoue M, Okajima K, Itoh K, et al. Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients. Kidney Int 1987;32:198\u2013203. https:\/\/doi.org\/10.1038\/ki.1987.192; PMID:\u00a03656933.","DOI":"10.1038\/ki.1987.192"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Alvarez AM, Mukherjee D. Liver abnormalities in cardiac diseases and heart failure. Int J Angiol 2011;20:135\u201342. https:\/\/doi.org\/10.1055\/s-0031-1284434; PMID:\u00a022942628.","DOI":"10.1055\/s-0031-1284434"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Shinagawa H, Inomata T, Koitabashi T, et al. Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 2008;72:364\u20139. https:\/\/doi.org\/10.1253\/circj.72.364; PMID:\u00a018296830.","DOI":"10.1253\/circj.72.364"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Ambrosy AP, Gheorghiade M, Bubenek S, et al. The predictive value of transaminases at admission in patients hospitalized for heart failure: findings from the RO-AHFS registry. Eur Heart J Acute Cardiovasc Care 2013;2:99\u2013108. https:\/\/doi.org\/10.1177\/2048872612474906; PMID:\u00a024222818.","DOI":"10.1177\/2048872612474906"},{"key":"ref39","unstructured":"Metra M, Cotter G, Davison BA, et al. Effect of serelaxin on cardiac, renal, and hepatic biomarkers in the Relaxin in Acute Heart Failure (RELAX-AHF) development program: correlation with outcomes. J Am Coll Cardiol 2013;61:196\u2013206. https:\/\/doi.org\/10.1016\/j.jacc.2012.11.005; PMID:\u00a023273292."},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Borovac JA, Glavas D, Susilovic Grabovac Z, et al. Right ventricular free wall strain and congestive hepatopathy in patients with acute worsening of chronic heart failure: a CATSTAT-HF echo substudy. J Clin Med 2020;9:1317. https:\/\/doi.org\/10.3390\/jcm9051317; PMID:\u00a032370248","DOI":"10.3390\/jcm9051317"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Okada A, Sugano Y, Nagai T, et al. Prognostic value of prothrombin time international normalized ratio in acute decompensated heart failure \u2013 a combined marker of hepatic insufficiency and hemostatic abnormality. Circ J 2016;80:913\u201323. https:\/\/doi.org\/10.1253\/circj.CJ-15-1326; PMID:\u00a026924077.","DOI":"10.1253\/circj.CJ-15-1326"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ Can Med Assoc J 2005;172:367\u201379. https:\/\/doi.org\/10.1503\/cmaj.1040752; PMID:\u00a015684121.","DOI":"10.1503\/cmaj.1040752"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Hiki M, Kasai T, Sato A, et al. Relationship between serum levels of pancreatic exocrine enzymes on admission and long-term clinical outcomes in patients with acute decompensated heart failure. J Clin Med 2025;14:1500. https:\/\/doi.org\/10.3390\/jcm14051500; PMID:\u00a040094976.","DOI":"10.3390\/jcm14051500"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Chioncel O, Benson L, Crespo-Leiro MG, et al. Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry. Eur J Prev Cardiol 2023;30:1346\u201358. https:\/\/doi.org\/10.1093\/eurjpc\/zwad151; PMID:\u00a037172316.","DOI":"10.1093\/eurjpc\/zwad151"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Turfan M, Tasal A, Erdogan E, et al. Serum gamma-glutamyl transferase levels and in-hospital mortality in patients with acute heart failure. Kardiol Pol 2014;72:735\u20139. https:\/\/doi.org\/10.5603\/KP.a2014.0048; PMID:\u00a024526562.","DOI":"10.5603\/KP.a2014.0048"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Butt A, Padkins M, Crespo-Diaz R, et al. Hepatic biomarker abnormalities in the cardiac intensive care unit: proposed criteria for cardiohepatic syndrome. JACC Adv 2025;4:101464. https:\/\/doi.org\/10.1016\/j.jacadv.2024.101464; PMID:\u00a039850044.","DOI":"10.1016\/j.jacadv.2024.101464"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Biegus J, Zymli\u0144ski R, Sokolski M, et al. Liver function tests in patients with acute heart failure. Pol Arch Med Wewn 2012;122:471\u20139. https:\/\/doi.org\/10.20452\/pamw.1413; PMID:\u00a023037318.","DOI":"10.20452\/pamw.1413"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Feng KY, Ambrosy AP, Zhou Z, et al. Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial. Eur J Heart Fail 2023;25:553\u201361. https:\/\/doi.org\/10.1002\/ejhf.2809; PMID:\u00a036823954.","DOI":"10.1002\/ejhf.2809"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Dastjerdi P, Mahalleh M, Shayesteh H, et al. Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis. BMC Cardiovasc Disord 2025;25:244. https:\/\/doi.org\/10.1186\/s12872-025-04647-2; PMID:\u00a040175926.","DOI":"10.1186\/s12872-025-04647-2"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Nikolaou M, Mebazaa A. Cardiohepatic interactions in heart failure: clinical and therapeutic implications. Contin Cardiol Educ 2017;3:117\u201320. https:\/\/doi.org\/10.1002\/cce2.63.","DOI":"10.1002\/cce2.63"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Matsue Y, Kagiyama N, Yamaguchi T, et al. Clinical and prognostic values of ALBI score in patients with acute heart failure. Heart Lung Circ 2020;29:1328\u201337. https:\/\/doi.org\/10.1016\/j.hlc.2019.12.003; PMID:\u00a032165085.","DOI":"10.1016\/j.hlc.2019.12.003"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"Biegus J, Zymli\u0144ski R, Sokolski M, et al. Impaired hepato-renal function defined by the MELD XI score as prognosticator in acute heart failure. Eur J Heart Fail 2016;18:1518\u201321. https:\/\/doi.org\/10.1002\/ejhf.644; PMID:\u00a027709804.","DOI":"10.1002\/ejhf.644"},{"key":"ref53","doi-asserted-by":"crossref","unstructured":"Curcio F, Amarelli C, Chiappetti R, et al. MELD score predicts outcomes in patients with advanced heart failure: a longitudinal evaluation. ESC Heart Fail 2025;12:839\u201347. https:\/\/doi.org\/10.1002\/ehf2.15002; PMID:\u00a039644505.","DOI":"10.1002\/ehf2.15002"},{"key":"ref54","doi-asserted-by":"crossref","unstructured":"Verbrugge FH, Dupont M, Steels P, et al. Abdominal contributions to cardiorenal dysfunction in congestive heart failure. J Am Coll Cardiol 2013;62:485\u201395. https:\/\/doi.org\/10.1016\/j.jacc.2013.04.070; PMID:\u00a023747781.","DOI":"10.1016\/j.jacc.2013.04.070"},{"key":"ref55","doi-asserted-by":"crossref","unstructured":"Legrand M, Mebazaa A, Ronco C, Januzzi JL. When cardiac failure, kidney dysfunction, and kidney injury intersect in acute conditions: the case of cardiorenal syndrome. Crit Care Med 2014;42:2109\u201317. https:\/\/doi.org\/10.1097\/CCM.0000000000000404; PMID:\u00a024810531.","DOI":"10.1097\/CCM.0000000000000404"},{"key":"ref56","doi-asserted-by":"crossref","unstructured":"Poelzl G, Ess M, Mussner-Seeber C, et al. Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Investig 2012;42:153\u201363. https:\/\/doi.org\/10.1111\/j.1365-2362.2011.02573.x; PMID:\u00a021806605.","DOI":"10.1111\/j.1365-2362.2011.02573.x"},{"key":"ref57","unstructured":"Kim MS, Kato TS, Farr M, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 2013;61:2253\u201361. https:\/\/doi.org\/10.1016\/j.jacc.2012.12.056; PMID:\u00a023563127."},{"key":"ref58","doi-asserted-by":"crossref","unstructured":"Yalcin YC, Muslem R, Veen KM, et al. Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2020;57:920\u20138. https:\/\/doi.org\/10.1093\/ejcts\/ezz337; PMID:\u00a031828334.","DOI":"10.1093\/ejcts\/ezz337"},{"key":"ref59","doi-asserted-by":"crossref","unstructured":"Liao S, Lu X, Cheang I, et al. Prognostic value of the modified Model for End-stage Liver Disease (MELD) score including albumin in acute heart failure. BMC Cardiovasc Disord 2021;21:128. https:\/\/doi.org\/10.1186\/s12872-021-01941-7; PMID:\u00a033750318.","DOI":"10.1186\/s12872-021-01941-7"},{"key":"ref60","doi-asserted-by":"crossref","unstructured":"Maeda D, Sakane K, Kanzaki Y, et al. Relation of aspartate aminotransferase to alanine aminotransferase ratio to nutritional status and prognosis in patients with acute heart failure. Am J Cardiol 2021;139:64\u201370. https:\/\/doi.org\/10.1016\/j.amjcard.2020.10.036; PMID:\u00a033115639.","DOI":"10.1016\/j.amjcard.2020.10.036"},{"key":"ref61","doi-asserted-by":"crossref","unstructured":"Shirakabe A, Okazaki H, Matsushita M, et al. Clinical significance of the Fibrosis-4 index in patients with acute heart failure requiring intensive care. Int Heart J 2021;62:858\u201365. https:\/\/doi.org\/10.1536\/ihj.20-793; PMID:\u00a034276014.","DOI":"10.1536\/ihj.20-793"},{"key":"ref62","doi-asserted-by":"crossref","unstructured":"Chioncel O, Collins SP, Ambrosy AP, et al. Pulmonary oedema \u2013 therapeutic targets. Card Fail Rev 2015;1:38\u201345. https:\/\/doi.org\/10.15420\/CFR.2015.01.01.38; PMID:\u00a028785430.","DOI":"10.15420\/CFR.2015.01.01.38"},{"key":"ref63","doi-asserted-by":"crossref","unstructured":"Ye L, Chang AJ, Chioncel O, et al. A spotlight on congestion in acute heart failure: a joint session with the Romanian Society of Cardiology (part I). Heart Fail Rev 2025;30:883\u201398. https:\/\/doi.org\/10.1007\/s10741-025-10515-0; PMID:\u00a040299252.","DOI":"10.1007\/s10741-025-10515-0"},{"key":"ref64","doi-asserted-by":"crossref","unstructured":"Geavlete O, Collins SP, Mebazaa A, et al. Hypertensive acute heart failure: a critical perspective on definition, epidemiology, pathophysiology, and prognosis \u2013 a narrative review: a joint session with the Romanian Society of Cardiology (part II). Heart Fail Rev 2025;30:1323\u201340. https:\/\/doi.org\/10.1007\/S10741-025-10551-W; PMID:\u00a040892348.","DOI":"10.1007\/s10741-025-10551-w"},{"key":"ref65","doi-asserted-by":"crossref","unstructured":"Jasiewicz M, Siedlaczek M, Kasprzak M, et al. Elevated serum transaminases in patients with acute coronary syndromes: do we need a revision of exclusion criteria for clinical trials? Cardiol J 2023;30:747\u201352. https:\/\/doi.org\/10.5603\/CJ.a2021.0081; PMID:\u00a034355781.","DOI":"10.5603\/CJ.a2021.0081"},{"key":"ref66","doi-asserted-by":"crossref","unstructured":"Li J, Zhao Z, Jiang H, et al. Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction. BMC Cardiovasc Disord 2021;21:82. https:\/\/doi.org\/10.1186\/s12872-021-01903-z; PMID:\u00a033563221.","DOI":"10.1186\/s12872-021-01903-z"},{"key":"ref67","doi-asserted-by":"crossref","unstructured":"Ndrepepa G, Holdenrieder S, Kastrati A. Prognostic value of De Ritis ratio in patients with acute myocardial infarction. Clin Chim Acta 2022;535:75\u201381. https:\/\/doi.org\/10.1016\/j.cca.2022.08.016; PMID:\u00a035985502.","DOI":"10.1016\/j.cca.2022.08.016"},{"key":"ref68","doi-asserted-by":"crossref","unstructured":"Harjola VP, Parissis J, Bauersachs J, et al. Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020;22:1298\u2013314. https:\/\/doi.org\/10.1002\/ejhf.1831; PMID:\u00a032347648.","DOI":"10.1002\/ejhf.1831"},{"key":"ref69","doi-asserted-by":"crossref","unstructured":"Aslan S, Meral M, Akgun M, et al. Liver dysfunction in patients with acute pulmonary embolism. Hepatol Res 2007;37:205\u201313. https:\/\/doi.org\/10.1111\/j.1872-034X.2007.00014.x; PMID:\u00a017362303.","DOI":"10.1111\/j.1872-034X.2007.00014.x"},{"key":"ref70","unstructured":"Chioncel O, Adamo M, Nikolaou M, et al. Acute heart failure and valvular heart disease: a scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology. Eur J Heart Fail 2023;25:1025\u201348. https:\/\/doi.org\/10.1002\/ejhf.2918; PMID:\u00a037312239."},{"key":"ref71","doi-asserted-by":"crossref","unstructured":"Nickel NP, Galura GM, Zuckerman MJ, et al. Liver abnormalities in pulmonary arterial hypertension. Pulm Circ 2021;11:20458940211054304. https:\/\/doi.org\/10.1177\/20458940211054304; PMID:\u00a034707859.","DOI":"10.1177\/20458940211054304"},{"key":"ref72","doi-asserted-by":"crossref","unstructured":"Matei DC, Antohi EL, Radu RI, et al. Predictors of in-hospital mortality in Type A acute aortic syndrome: data from the RENADA-RO registry. Heart Lung Circ 2024;33:1348\u201356. https:\/\/doi.org\/10.1016\/j.hlc.2024.02.016; PMID:\u00a038955595.","DOI":"10.1016\/j.hlc.2024.02.016"},{"key":"ref73","unstructured":"McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599\u2013726 https:\/\/doi.org\/10.1093\/eurheartj\/ehab368; PMID:\u00a034447992."},{"key":"ref74","doi-asserted-by":"crossref","unstructured":"Fernandes J, Costa R, Guerreiro R, et al. Co-administration of albumin and furosemide in acute heart failure with diuretics resistance. Acta Med Port 2023;36:193\u2013201. https:\/\/doi.org\/10.20344\/amp.17714; PMID:\u00a036762993.","DOI":"10.20344\/amp.17714"},{"key":"ref75","doi-asserted-by":"crossref","unstructured":"Pompili E, Zaccherini G, Baldassarre M, et al. Albumin administration in internal medicine: a journey between effectiveness and futility. Eur J Intern Med 2023;117:28\u201337. https:\/\/doi.org\/10.1016\/j.ejim.2023.07.003; PMID:\u00a037423819.","DOI":"10.1016\/j.ejim.2023.07.003"},{"key":"ref76","doi-asserted-by":"crossref","unstructured":"Ghazal M, Khalife WI. Hypoalbuminemia in heart failure: pathophysiology, clinical implications, and management strategies. Heart Fail Rev 2025;30:1407\u201314. https:\/\/doi.org\/10.1007\/s10741-025-10558-3; PMID:\u00a040913686.","DOI":"10.1007\/s10741-025-10558-3"},{"key":"ref77","doi-asserted-by":"crossref","unstructured":"Jung C, Kelm M, Westenfeld R. Liver function during mechanical circulatory support: from witness to prognostic determinant. Crit Care 2016;20:134. https:\/\/doi.org\/10.1186\/s13054-016-1312-7; PMID:\u00a027245921.","DOI":"10.1186\/s13054-016-1312-7"},{"key":"ref78","doi-asserted-by":"crossref","unstructured":"Li Z, Lin D, Miao J, et al. Effects of transcatheter tricuspid valve replacement on hepatic and renal function in severe TR. Int J Cardiol Heart Vasc 2025;59:101714. https:\/\/doi.org\/10.1016\/j.ijcha.2025.101714; PMID:\u00a040546790.","DOI":"10.1016\/j.ijcha.2025.101714"},{"key":"ref79","doi-asserted-by":"crossref","unstructured":"Messika-Zeitoun D, Burwash IG, Dreyfus J. Tricuspid transcatheter edge-to-edge valve repair: sooner rather than later. JACC Cardiovasc Interv 2022;15:190\u20132. https:\/\/doi.org\/10.1016\/j.jcin.2021.11.014; PMID:\u00a035057990.","DOI":"10.1016\/j.jcin.2021.11.014"},{"key":"ref80","doi-asserted-by":"crossref","unstructured":"Jorde UP, Benza R, McCarthy PM, et al. Impact of renal and liver function on clinical outcomes following tricuspid valve transcatheter edge-to-edge repair. J Am Coll Cardiol 2024;84:2446\u201356. https:\/\/doi.org\/10.1016\/j.jacc.2024.08.044; PMID:\u00a039222896.","DOI":"10.1016\/j.jacc.2024.08.044"},{"key":"ref81","doi-asserted-by":"crossref","unstructured":"Stolz L, Orban M, Besler C, et al. Cardiohepatic syndrome is associated with poor prognosis in patients undergoing tricuspid transcatheter edge-to-edge valve repair. JACC Cardiovasc Interv 2022;15:179\u201389. https:\/\/doi.org\/10.1016\/j.jcin.2021.10.033; PMID:\u00a035057989.","DOI":"10.1016\/j.jcin.2021.10.033"},{"key":"ref82","doi-asserted-by":"crossref","unstructured":"Adamopoulos S, Bonios M, Ben Gal T, et al. Right heart failure with left ventricular assist devices: preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024;26:2304\u201322. https:\/\/doi.org\/10.1002\/ejhf.3323; PMID:\u00a038853659.","DOI":"10.1002\/ejhf.3323"},{"key":"ref83","doi-asserted-by":"crossref","unstructured":"Majumder K, Spratt JR, Holley CT, et al. Impact of postoperative liver dysfunction on survival after left ventricular assist device implantation. Ann Thorac Surg 2017;104:1556\u201362. https:\/\/doi.org\/10.1016\/j.athoracsur.2017.04.048; PMID:\u00a028760474.","DOI":"10.1016\/j.athoracsur.2017.04.048"},{"key":"ref84","doi-asserted-by":"crossref","unstructured":"Masai T, Sawa Y, Ohtake S, et al. Hepatic dysfunction after left ventricular mechanical assist in patients with end-stage heart failure: role of inflammatory response and hepatic microcirculation. Ann Thorac Surg 2002;73:549\u201355. https:\/\/doi.org\/10.1016\/S0003-4975(01)03510-X; PMID:\u00a011845873.","DOI":"10.1016\/S0003-4975(01)03510-X"},{"key":"ref85","doi-asserted-by":"crossref","unstructured":"Cotter G, Davison B, Chioncel O. Enhanced decongestive therapy in patients with acute heart failure: JACC review topic of the week. J Am Coll Cardiol 2024;83:1243\u201352. https:\/\/doi.org\/10.1016\/j.jacc.2024.01.029; PMID:\u00a038538204.","DOI":"10.1016\/j.jacc.2024.01.029"},{"key":"ref86","unstructured":"Davison BA, Abbate A, Cotter G, et al. Effects of anti-inflammatory therapy in acute heart failure: a systematic review and meta-analysis. Heart Fail Rev 2025;30:575\u201387. https:\/\/doi.org\/10.1007\/s10741-025-10491-5; PMID:\u00a039939545."},{"key":"ref87","doi-asserted-by":"crossref","unstructured":"Chioncel O, Davison B, Adamo M, et al. Non-cardiac comorbidities and intensive up-titration of oral treatment in patients recently hospitalized for heart failure: insights from the STRONG-HF trial. Eur J Heart Fail 2023;25:1994\u20132006. https:\/\/doi.org\/10.1002\/ejhf.3039; PMID:\u00a037728038.","DOI":"10.1002\/ejhf.3039"},{"key":"ref88","doi-asserted-by":"crossref","unstructured":"Christodorescu R, Geavlete O, Ferrini M, et al. Translating the 2021 ESC heart failure guideline recommendations in daily practice: results from a heart failure survey. A scientific statement of the ESC Council for Cardiology Practice and the Heart Failure Association of the ESC. Eur J Heart Fail 2025;27:412\u201320. https:\/\/doi.org\/10.1002\/ejhf.3444; PMID:\u00a039318024.","DOI":"10.1002\/ejhf.3444"},{"key":"ref89","doi-asserted-by":"crossref","unstructured":"Miyama H, Shiraishi Y, Kohsaka S, et al. Abnormal liver function tests and long-term outcomes in patients discharged after acute heart failure. J Clin Med 2021;10:1730. https:\/\/doi.org\/10.3390\/jcm10081730; PMID:\u00a033923618.","DOI":"10.3390\/jcm10081730"},{"key":"ref90","doi-asserted-by":"crossref","unstructured":"Moreira-Silva S, Urbano J, Moura MC, et al. Liver cytolysis in acute heart failure: what does it mean? Clinical profile and outcomes of a prospective hospital cohort. Int J Cardiol 2016;221:422\u20137. https:\/\/doi.org\/10.1016\/j.ijcard.2016.06.163; PMID:\u00a027409567.","DOI":"10.1016\/j.ijcard.2016.06.163"},{"key":"ref91","doi-asserted-by":"crossref","unstructured":"Okada A, Sugano Y, Nagai T, et al. Usefulness of the direct and\/or total bilirubin to predict adverse outcomes in patients with acute decompensated heart failure. Am J Cardiol 2017;119:2035\u201341. https:\/\/doi.org\/10.1016\/j.amjcard.2017.03.033; PMID:\u00a028456315.","DOI":"10.1016\/j.amjcard.2017.03.033"},{"key":"ref92","doi-asserted-by":"crossref","unstructured":"Ancion A, Allepaerts S, Oury C, et al. Serum albumin level and hospital mortality in acute non-ischemic heart failure. ESC Heart Fail 2017;4:138\u201345. https:\/\/doi.org\/10.1002\/EHF2.12128; PMID:\u00a028451450.","DOI":"10.1002\/ehf2.12128"},{"key":"ref93","doi-asserted-by":"crossref","unstructured":"Kinugasa Y, Kato M, Sugihara S, et al. A simple risk score to predict in-hospital death of elderly patients with acute decompensated heart failure \u2013 hypoalbuminemia as an additional prognostic factor. Circ J 2009;73:2276\u201381. https:\/\/doi.org\/10.1253\/circj.CJ-09-0498; PMID:\u00a019822976.","DOI":"10.1253\/circj.CJ-09-0498"},{"key":"ref94","doi-asserted-by":"crossref","unstructured":"Chioncel O, Mebazaa A, Farmakis D, et al. Pathophysiology and clinical use of agents with vasodilator properties in acute heart failure. A scientific statement of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2025;27:1067\u201388. https:\/\/doi.org\/10.1002\/EJHF.3673; PMID:\u00a040320261.","DOI":"10.1002\/ejhf.3673"}],"container-title":["Cardiac Failure Review"],"original-title":[],"link":[{"URL":"https:\/\/www.cfrjournal.com\/articleindex\/cfr.2025.51","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:42:41Z","timestamp":1783935761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cfrjournal.com\/articleindex\/cfr.2025.51"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":95,"URL":"https:\/\/doi.org\/10.15420\/cfr.2025.51","relation":{},"ISSN":["2057-7540","2057-7559"],"issn-type":[{"value":"2057-7540","type":"print"},{"value":"2057-7559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"e17"}}