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Prognostic Implication of Liver Function Tests in Heart Failure With Preserved Ejection Fraction Without Chronic

Weihao Liang1,2, Xin He1,2, Dexi Wu1,2

  • 1Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Frontiers in Cardiovascular Medicine
|May 31, 2021
PubMed

Insights

Elevated liver cholestasis markers, total bilirubin (TBIL) and alkaline phosphatase (ALP), predict poor outcomes in heart failure with preserved ejection fraction (HFpEF). Liver enzymes like ALT and AST showed no prognostic value in these patients.

Area of Science:

  • Cardiology
  • Hepatology
  • Clinical Medicine

Background:

  • Liver dysfunction is common in heart failure (HF) patients.
  • The prognostic value of liver function tests (LFTs) in HFpEF is not well-established.
  • Previous studies have not specifically investigated LFTs in HFpEF.

Purpose of the Study:

  • To assess the prognostic significance of LFTs in patients with heart failure with preserved ejection fraction (HFpEF).
  • To determine if specific LFTs can predict adverse outcomes in HFpEF.

Main Methods:

  • A post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT).
  • Cox proportional hazards models were used to analyze the association between LFTs and outcomes.
  • Primary outcome: composite of cardiovascular mortality, HF hospitalization, and aborted cardiac arrest. Secondary outcomes: cardiovascular mortality and HF hospitalization.

Main Results:

  • Elevated total bilirubin (TBIL) and alkaline phosphatase (ALP) were significantly associated with increased risk of the primary composite outcome, cardiovascular mortality, and HF hospitalization.
  • Aspartate transaminase (AST) and alanine transaminase (ALT) were not associated with any of the studied outcomes.
  • Adjusted hazard ratios for TBIL and ALP indicated a notable increase in risk for adverse events.

Conclusions:

  • Elevated serum cholestasis markers (TBIL and ALP) are significant predictors of poor prognosis in HFpEF patients without chronic liver disease.
  • Elevated liver enzymes (ALT and AST) do not appear to have prognostic value in this HFpEF cohort.
  • These findings highlight the importance of cholestasis markers in risk stratification for HFpEF.

Keywords:
cholestasiscongestive hepatopathyheart failure with preserved ejection fractionliver function testsprognosis

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