Clinical predictors of hepatic fibrosis in chronic advanced heart failure

The clinical features associated with liver disease in patients with advanced heart failure are poorly defined. We investigated the histopathologic spectrum of liver disease in a contemporary population with heart failure to identify the clinical correlates of hepatic fibrosis.

We identified 61 patients with advanced heart failure undergoing evaluation for ventricular assist device or cardiac transplantation from 1995 to 2006, who had liver tissue obtained during the same time period. Electronic medical records were reviewed for clinical data. Biopsy specimens were scored for hepatic fibrosis. Forty-seven patients (79.7%) had hepatic fibrosis on liver biopsy. Of these, 47% had severe fibrosis (grade 3 or 4). Relative to those without fibrosis, patients with hepatic fibrosis were more likely to have renal dysfunction, moderate or severe tricuspid regurgitation (odds ratio, 5.0; 95% CI, 1.2 to 21.7), and obstructive or mixed liver function test abnormalities (odds ratio, 5.7; 95% CI, 1.4 to 22.3). As anticipated, patients with no or mild fibrosis (grade 1 or 2) on transjugular liver biopsy were more likely to undergo ventricular assist device or heart transplant than patients with severe fibrosis (odds ratio, 7.8; 95% CI, 1.4 to 44.0). Accordingly, patients with severe fibrosis were less likely to be alive at the time of data collection (odds ratio, 0.07; 95% CI, 0.01 to 0.42).

Hepatic fibrosis is common in patients with advanced heart failure. Renal dysfunction, significant tricuspid regurgitation and abnormal liver function tests are associated with hepatic fibrosis, but the predictive value of other clinical features is limited. Liver biopsy should be considered in patients undergoing ventricular assist device or transplant evaluation.