Symmetrical Peripheral Gangrene Associated with Low Output Cardiac Failure

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.

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

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.618816 ◽

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.

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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

European Journal of Heart Failure ◽

10.1093/eurjhf/hfs007 ◽

2012 ◽

Vol 14 (3) ◽

pp. 302-311 ◽

Cited By ~ 102

Author(s):

Andrew P. Ambrosy ◽

Muthiah Vaduganathan ◽

Mark D. Huffman ◽

Sadiya Khan ◽

Mary J. Kwasny ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Ejection Fraction ◽

Predictive Value ◽

Clinical Course ◽

Liver Function Tests ◽

Reduced Ejection Fraction ◽

Function Tests

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Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Journal of Cardiovascular Diseases & Diagnosis ◽

10.4172/2329-9517.1000300 ◽

2017 ◽

Vol 05 (06) ◽

Author(s):

Koganti S ◽

Dasgupta S ◽

Crossman R ◽

Banerjee P

Keyword(s):

Heart Failure ◽

Liver Function ◽

Ejection Fraction ◽

Outpatient Clinic ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Reduced Ejection Fraction ◽

Function Tests ◽

New Diagnosis

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0951 ◽

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.

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