Liver stiffness as measured by transient elastography is an independent predictor of outcomes in patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.X Avila ◽  
H.V Villacorta ◽  
C.M.L Cabrita ◽  
R.B.G Santos ◽  
M.L Ribeiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Disease ◽  
Chronic Heart Failure ◽  
Liver Function ◽  
Ejection Fraction ◽  
Independent Predictor ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Liver Function Tests ◽  
Funding Source

Abstract Background Patients with chronic heart failure (HF) may have liver abnormalities due to systemic congestion. Transient elastography (TE) has been used to assess liver stiffness (LS) in patients with primary liver disease. Some studies have suggested that congestion can influence liver stiffness. Purposes We sought to assess the role of LS in the prediction of outcomes in patients with chronic HF. Methods Nine-three consecutive patients with chronic HF were screened and fulfilled the inclusion criteria which consisted of signs or symptoms of HF and left ventricle ejection fraction (LVEF) less than 50%. Patients with concomitant liver disease were excluded or techical problems during TE. Patients underwent routine laboratory tests, liver function tests and TE. The primary endpoint was time to first event, which was defined as a composite of cardiovascular death or HF hospitalization. Results Mean follow up was 219±86 days. Nine patients were excluded due to exclusion criteria or technical problems during the TE. Eighty-four patients were included in the final analysis. Mean age was 63.2±12.2 and 57 (67.8%) were male. Mean ejection fraction and median NT-proBNP were, respectively, 38.7±14.3% and 1,140 pg/mL (interquartile range 224.3–2,810.3). Median LS for the entire population was 5.35 (3.7–10.65) kPa. LS correlated with NT-proBNP (r=0.54; p<0.0001), total bilirubin (r=0.47; p<0.001), direct bilirubin (r=0.66; p<0.0001), alkaline phosphatase (r=0.57; p<0.0001); γ-glutamyl-transpeptidase (r=0.59; p<0.0001), and age (r=−0.22; p=0.03). A Receiver Operating Characteristic (ROC) curve was performed and a cut point of 5.9 kPa showed sensitivity of 80% and specificity of 64.1% with area under the curve of 0.73. Mean event-free survival time for patients above and below this cutoff was 215.2±20 vs 302.8±7.2 days (p=0.0001; log rank test). Using Cox proportional hazard model (independent variables: LS as a continuous variable, age, gender, NT-proBNP, LVEF, and creatinine), only LS was independently associated with the primary endpoint (hazard ratio 1.05, 95% confidence interval 1.01–1.09; for each increment of one unit of LS). Conclusion LS correlates with biomarkers of myocardial stretch and several liver function tests and is an independent predictor of outcomes in patients with chronic HF. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Own funding and examinations carried out with a welfare fund.

scholarly journals Prognostic Implication of Liver Function Tests in Heart Failure With Preserved Ejection Fraction Without Chronic Hepatic Diseases: Insight From TOPCAT Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Weihao Liang ◽  
Xin He ◽  
Dexi Wu ◽  
Ruicong Xue ◽  
Bin Dong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Function ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Liver Function Tests ◽  
Preserved Ejection Fraction ◽  
Hepatic Diseases ◽  
Function Tests

Background: Liver dysfunction is prevalent in patients with heart failure (HF), but the prognostic significance of liver function tests (LFTs) remains controversial. Heart failure with preserved ejection fraction (HFpEF) had been introduced for some time, but no previous study had focused on LFTs in HFpEF. Thus, we aim to evaluate the prognostic significance of LFTs in well-defined HFpEF patients.Methods and Results: We conveyed a post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT). The primary outcome was the composite of cardiovascular mortality, HF hospitalization, and aborted cardiac arrest, and the secondary outcomes were cardiovascular mortality and HF hospitalization. In Cox proportional hazards models, aspartate transaminase (AST) and alanine transaminase (ALT) were not associated with any of the outcomes. On the contrary, increases in total bilirubin (TBIL) and alkaline phosphatase (ALP) were associated with increased risks of the primary outcome [TBIL: adjusted hazard ratio (HR), 1.17; 95% confidence interval (CI) 1.08–1.26; ALP: adjusted HR, 1.12; 95% CI 1.04–1.21], cardiovascular mortality (TBIL: adjusted HR, 1.16; 95% CI 1.02–1.31; ALP: adjusted HR, 1.16; 95% CI 1.05–1.28), and HF hospitalization (TBIL: adjusted HR, 1.22; 95% CI 1.12–1.33; ALP: adjusted HR, 1.12; 95% CI 1.03–1.23).Conclusion: Elevated serum cholestasis markers TBIL and ALP were significantly associated with a poor outcome in HFpEF patients without chronic hepatic diseases, while elevated ALT and AST were not.

scholarly journals Decompensated Chronic Heart Failure: Increased Liver Stiffness Measured by Means of Transient Elastography

Radiology ◽  
2010 ◽  
Vol 257 (3) ◽  
pp. 872-878 ◽  
Author(s):  
Agostino Colli ◽  
Pietro Pozzoni ◽  
Alessandra Berzuini ◽  
Alessandro Gerosa ◽  
Cristina Canovi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Transient Elastography ◽  
Liver Stiffness

The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure

1995 ◽  
Vol 16 (11) ◽  
pp. 1613-1618 ◽  
Author(s):  
P. BATIN ◽  
M. WICKENS ◽  
D. MCENTEGART ◽  
L. FULLWOOD ◽  
A. J. COWLEY
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Liver Function ◽  
Liver Function Tests ◽  
Function Tests

Abstract 15719: Levosimendan Improves Liver Function in Patients With Advanced Chronic Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregor Zemljic ◽  
Ajda Anzic Drofenik ◽  
Andraz Cerar ◽  
Sabina Frljak ◽  
Gregor Poglajen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Liver Function ◽  
Ejection Fraction ◽  
Total Bilirubin ◽  
Left Ventricular ◽  
Direct Bilirubin ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Introduction: Although there is evidence of beneficial effects of levosimendan on heart and renal function in patients with advanced chronic heart failure, the impact of levosimendan on liver function remains undefined. Hypothesis: We investigated the effects of levosimendan on liver function in patients with advanced chronic heart failure. Methods: We enrolled 299 patients with chronic heart failure (NYHA class 3) and left ventricular ejection fraction <30%, aged between 18 and 80 years. 150 patients were randomized to receive levosimendan (0.1 mcg/kg/min infusion for 24 hours; LS Group), and 149 received no levosimendan (Controls). Liver function was evaluated at baseline and again at 3 months by measuring total bilirubin, direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (gGT) and lactate dehydrogenase (LDH). Results: At baseline, the groups did not differ in age (59±11 years in LS Group vs. 60±10 years in Controls; P=0.74), sex (male: 77% vs. 75%; P=0.36), heart failure etiology (ischemic: 45% vs. 47%; P=0.64), left ventricular ejection fraction (27±2% vs. 26±3%; P=0.97), and plasma NT-proBNP levels (4758±3912 pg/mL vs. 5111±4271 pg/mL; P=0.71). Liver function tests of both groups at the time of enrollment were comparable. At 3 months we found a significant improvement in liver function in LS Group, but not in Controls, with a decrease in total bilirubin (21.9±16.4 μmol/L to 18.5±13.1 μmol/L in LS Group vs. 22.1±17.1 μmol/L to 22.0±17.3 μmol/L in Controls; P<0.001), direct bilirubin (8.6±6.4 μmol/L to 7.1±5.2 μmol/L vs. 8.7±6.6 μmol/L to 8.8±6.7 μmol/L; P<0.001), AST (1.18±0.98 μkat/L to 0.42±0.40 μkat/L vs. 1.16±0.92 μkat/L to 1.15±0.87 μkat/L; P=0.03), ALT (0.73±0.71 μkat/L to 0.50±0.49 μkat/L vs. 0.75±0.77 μkat/L to 0.74±0.70 μkat/L; P=0.006), gGT (2.25±2.30 μkat/L to 1.87±1.94 μkat/L vs. 2.23±2.18 μkat/L to 2.22±2.16 μkat/L; P=0.003) and LDH (3.66±2.46 μkat/L to 3.36±1.96 μkat/L vs. 3.58±2.77 μkat/L to 3.62±2.82 μkat/L; P=0.006). Conclusions: Levosimendan appears to improve long-term liver function in advanced chronic heart failure patients. Thus, repetitive levosimendan infusions may potentially slow the progression of cardio-hepatic syndrome to cardiac cirrhosis.

P5405Clinical and prognostic relevance of increased liver stiffness coupled with abnormal liver function tests in decompensated heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Soloveva ◽  
M Bayarsaikhan ◽  
O Lukina ◽  
E Troitskaya ◽  
S Bondari ◽  
...  
Keyword(s):  
Heart Failure ◽  
Alcohol Abuse ◽  
Liver Function ◽  
Liver Stiffness ◽  
Decompensated Heart Failure ◽  
Liver Function Tests ◽  
Abnormal Liver Function ◽  
Event Free Survival ◽  
Free Survival ◽  
Kaplan Meier

Abstract Objective Recent studies have demonstrated associations of either abnormal liver function tests (LFT) or liver stiffness (LS) increase with negative outcomes in decompensated heart failure (DHF). We aimed to assess incidence, clinical and prognostic relevance of combined increase of LS and LFT in DHF. Methods The study included 130 patients (73% male, 68±11 years [M±SD], myocardial infarction 49%, atrial fibrillation 63%, diabetes mellitus 39%, chronic kidney disease 24%, EF 39±14%, EF<40% 54%, NT-proBNP 3601 [1905; 6220] pg/ml, alcohol abuse 26.2%) hospitalized with DHF, in whom levels of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TB) and LS (using transient elastography) were assessed in the first 48 hours of admission. Patients with previous liver disease or acute hepatitis were excluded. Higher then upper normal limit levels of either AST/ ALT/ TB were considered as LFT increase; LS >5.9 kPa – as abnormal. Outcomes were assessed by phone contacts in 1, 3, 6 and 12 months. Kruskal–Wallis test, Pearson's chi-squared test and Kaplan-Meier survival analysis were used. P<0.05 was considered significant. Results Median LS was 11.1 (6.8; 24.5) kPa, median ALT 20.1 (14.9; 30.7) U/l, AST 26 (20; 36.3) U/l, TB 19 (13.2; 27) μmol/l. LS and ALT, AST, TB increase occurred in 79.2 and 15.4, 13.1, 40.8% patients. Based on combination of LS and LFT increase subjects were divided into 3 groups: without LS and LFT increase (G1, 16.2%), with only LS increase (G2, 33.1%) and both LS and LFT increase (G3, 46.1%). Isolated LFT increase was noted only in 6 (4.6%) patients. G3 compared to G2 and G1 was characterized by lower EF (33±14 vs 41±13 and 45±11%, p<0.001) and inferior vena cava (IVC) collapsibility (23.3 vs 41.9 and 61.9%, p=0.003), higher IVC diameter (2.4 [2; 2.6] vs 2.2 [2; 2.4] and 2 [1.95; 2.2] cm, p<0.001), right ventricular diameter (3.5 [3.2; 3.9] vs 3.2 [3; 3.6] and 3 [2.9; 3.1] cm, p<0.001), pulmonary artery pressure (56 [45; 66] vs 50 [37; 65] and 40 [33; 49] mmHg, p=0.014), higher rate of tricuspid regurgitation (70 vs 44.2 and 28.6%, p=0.001). Groups did not differ by alcohol abuse rate (p=0.152). Kaplan–Meier analysis of groups for all-cause death probability showed significant differences (figure): event-free survival for G3 vs G1 and G2 was 64.9 vs 81 and 95% (log rank p=0.011, χ2=6.5 for G3 vs G1; log rank p=0.081, χ2=3.1 for G3 vs G2). HF readmission probability was significantly higher in G3 vs G2 and G1: corresponding event-free survival was 50.9 vs 66.7 and 80% (log rank p=0.012, χ2=6.3 for G3 vs G1; log rank p=0.036, χ2=4.4 for G3 vs G2). Conclusions Combination of abnormal LFT and increased LS was observed in 46.1% of DHF patients and was associated with lower EF, more serious right-sided dysfunction and higher probability of negative long-term outcomes.

scholarly journals The prevalence and prognostic significance of liver disease in chronic heart failure

2021 ◽  
Vol 30 (1) ◽  
pp. 70-74
Author(s):  
O. Arisheva ◽  
I. Garmash ◽  
B. Sarlykov
Keyword(s):  
Heart Failure ◽  
Liver Disease ◽  
Liver Function ◽  
Hepatic Injury ◽  
Prognostic Significance ◽  
Liver Stiffness ◽  
Future Research ◽  
Alcoholic Fatty Liver ◽  
Reduced Ejection Fraction ◽  
Function Test

Heart failure (HF) is characterized by systemic hemodynamicchanges that negatively affect all organs, including liver.Large-scale clinical trials, which involved mostly patients withheart failure and reduced ejection fraction, showed the highprevalence of abnormal liver function tests that had poorprognosis. Patients with common comorbidities, such as obesity, diabetes mellitus, and arterial hypertension, frequentlypresent with both non-alcoholic fatty liver disease (NAFLD)and subclinical HF. The association between these two conditions, both leading to hepatic injury, was shown in severalstudies. The criteria for non-invasive diagnosis of cardiogenicliver damage, including fibrosis, are not established. Studiessuggested the correlation between liver stiffness measured byelastography and liver function test abnormalities in patientswith decompensated HF. Moreover, liver stiffness was a predictor of worse outcomes. However, liver stiffness thresholdsare not defined for patients with HF. The interpretation ofliver function test alterations in HF also remains ambiguous,and there is no unified classification of hepatic injury in HF.The role of NAFLD in patients with symptomatic HF is not wellunderstood and requires future research.

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