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Relationship between invasive hemodynamics and liver function in advanced heart failure

Julie K K Vishram-Nielsen1, Tania Deis1, Louise Balling1

  • 1Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.

Scandinavian Cardiovascular Journal : SCJ
|July 23, 2019
PubMed

Insights

In advanced heart failure patients, central venous pressure (CVP) correlates with liver function markers. Improving CVP through decongestion may enhance liver function in these patients.

Area of Science:

  • Cardiology
  • Hepatology
  • Internal Medicine

Background:

  • Advanced heart failure (AHF) significantly impacts multiple organ systems, including the liver.
  • Understanding the relationship between liver function (LF) and hemodynamics is crucial for managing AHF patients.
  • Optimizing medical therapy is key in AHF, but its effect on liver function requires further investigation.

Purpose of the Study:

  • To investigate the cross-sectional and longitudinal associations between liver function tests and invasive hemodynamic parameters in AHF patients.
  • To determine if interventions aimed at improving hemodynamics, such as decongestion, can positively influence liver function in AHF.

Main Methods:

  • Retrospective analysis of 309 AHF patients (left ventricular ejection fraction < 45%) undergoing right heart catheterization (RHC).
  • Hemodynamic measurements included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI), and mean arterial pressure (MAP).
  • Liver function was assessed via plasma alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, albumin, lactate dehydrogenase, and prothrombin time/International Normalized Ratio (PT/INR). RHC and LF were repeated in 33 patients.

Main Results:

  • Central venous pressure (CVP) showed significant associations with alkaline phosphatase (ALP), bilirubin, and international normalized ratio (INR).
  • Pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were associated with bilirubin levels.
  • Longitudinal analysis revealed that changes in CVP positively correlated with changes in bilirubin, a marker of biliary excretion.

Conclusions:

  • In optimally treated AHF patients, CVP is linked to both biliary excretion and liver synthesis markers.
  • Changes in CVP over time are associated with alterations in markers of biliary excretion.
  • Decongestion strategies may offer a therapeutic benefit by improving liver function in advanced heart failure.

Keywords:
advanced heart failurehemodynamicsliver functionright heart catheterizationright ventricular failurevolume overload

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