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

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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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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Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study

European Journal of Heart Failure ◽

10.1002/ejhf.532 ◽

2016 ◽

Vol 18 (7) ◽

pp. 830-839 ◽

Cited By ~ 33

Author(s):

Jan Biegus ◽

Hans L. Hillege ◽

Douwe Postmus ◽

Mattia. A.E. Valente ◽

Daniel M. Bloomfield ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Acute Heart Failure ◽

Clinical Characteristics ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests ◽

Protect Study

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Should We Confine the Cardio Hepatic Syndrome Only in Congestive Cardiac Failure Patients?

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1656458 ◽

2017 ◽

Vol 02 (01) ◽

pp. 042-046

Author(s):

B. Rajendra ◽

B. Sukanya ◽

Nayana Joshi

Keyword(s):

Heart Failure ◽

Liver Function ◽

Hepatic Dysfunction ◽

Liver Enzymes ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Drug Induced ◽

Function Tests ◽

Cardiology Department ◽

Patients With Heart Failure

AbstractIntroduction: Liver function abnormalities are not uncommon in patients with heart failure. Multiple reasons have been cited like impaired perfusion or elevated right-sided cardiac pressures, or are secondary to drug toxicity. In this study, we analyzed the patients admitted at our center to detect the profile of cardio-hepatic syndrome. This analysis may explore new etiologies for cardio-hepatic syndrome.Materials And Methods: This is an observational retrospective study done at our institute. We collected the liver function tests which were conducted in patients admitted in cardiology in 2015 (Jan to Dec at our center. Patients having abnormal liver function tests were analyzed for various etiologies. SGPT value > 45 Units per liter is considered as elevated.Results: Out of the patients admitted to cardiology department, SGPT and SGOT values are available in 2803 and 4577 patients respectively. Mean age of these patients was 58±12.9 yrs.In SGPT group 1881 were males. In 432(15.4%) patients SGPT was elevated. In them 326 (76%) were males. Among the patients in whom SGPT is elevated, also had elevated CPK and CPK-MB due to MI were in 154 patients (35.6%). In 24 patients (5.6%) SGPT was elevated along with NT pro BNP levels. Rest of the SGPT elevated patients (254 – 58.8%) does not come under CCF or MI category and out these patients about 146 patients were on either on statin or other drugs which can increase the liver enzymes. Still we require to evaluate the cause of hepatic abnormality in 106(24.5%) patients admitted with cardiac disease.Conclusions: Cardio-hepatic syndrome is not just confined to heart failure. Though heart failure, MI and drug induced hepatic dysfunction accounted for 75.5% of the etiology, we require to see present unknown the etiology for this sub group of cardio hepatic syndrome. Further elucidating the etiology for the remaining 24.5% cardio hepatic syndrome is of much interest.

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