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

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.

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Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial

European Heart Journal ◽

10.1093/eurheartj/ehs444 ◽

2013 ◽

Vol 34 (11) ◽

pp. 835-843 ◽

Cited By ~ 228

Author(s):

A. P. Ambrosy ◽

P. S. Pang ◽

S. Khan ◽

M. A. Konstam ◽

G. C. Fonarow ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Predictive Value ◽

Clinical Course ◽

Signs And Symptoms ◽

Reduced Ejection Fraction

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Abnormal Liver Function Tests and Long-Term Outcomes in Patients Discharged after Acute Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm10081730 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1730

Author(s):

Hiroshi Miyama ◽

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Ayumi Goda ◽

Yosuke Nishihata ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Adverse Outcomes ◽

Long Term Outcomes ◽

Function Tests ◽

Parameter Values

Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08–2.12, p = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.

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Liver Function Tests in Chronic Congestive Heart Failure

Circulation ◽

10.1161/01.cir.2.2.286 ◽

1950 ◽

Vol 2 (2) ◽

pp. 286-297 ◽

Cited By ~ 42

Author(s):

LEONARD FELDER ◽

ALVIN MUND ◽

JULIUS G. PARKER

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Liver Function ◽

Liver Function Tests ◽

Chronic Congestive Heart Failure ◽

Function Tests

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The Role of CEA and Liver Function Tests in the Detection of Hepatic Metastases From Colo-Rectal Cancer

HPB Surgery ◽

10.1155/1990/87874 ◽

1990 ◽

Vol 3 (1) ◽

pp. 29-37 ◽

Cited By ~ 2

Author(s):

G. Bonfanti ◽

Luigia Bombelli ◽

F. Bozzetti ◽

R. Doci ◽

L. Gennari ◽

...

Keyword(s):

Rectal Cancer ◽

Liver Function ◽

Liver Metastases ◽

Predictive Value ◽

Imaging Technique ◽

Hepatic Metastases ◽

Liver Function Tests ◽

Good Prediction ◽

Gamma Glutamyl Transpeptidase ◽

Function Tests

Carcinoembryonic antigen and some liver function tests (alkaline phosphatase, gamma-glutamyl-transpeptidase, lactic dehydrogenase and cholinesterase) were evaluated in patients with primary colorectal cancer in order to define their role in the pre-operative detection of liver metastases.The records of 278 consecutive patients admitted to the Istituto Nazionale Tumori of Milan between January 1982 and December 1983 who were suffering from primary invasive colo-rectal cancer and who underwent laparotomy were retrospectively analyzed.At laparotomy, liver metastases were found in 38 pts (13.7%). Considering single tests, CEA was the most sensitive (71%); no single test was found to be reliably predictive, when the result was abnormal. On the contrary, the normal value of each test was associated with a good prediction.When we considered all the five tests together in the single patient their predictive value, when abnormal, proved to be quite good only if four or five results were abnormal. On the other hand, liver metastases in the presence of all normal tests were found only in two patients, so giving a negative predictive value of about 97%.So we conclude that, in the lack of an infallable imaging technique for liver evaluation, in the presence of all normal tests any other investigation on the liver could be avoided. However, when liver tests are pathologic, some other imaging technique should be performed in order to supply the surgeon with information about the extent and the spread of the metastases.

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