Related Experiment Videos
Liver function abnormalities in chronic heart failure. Influence of systemic hemodynamics
Insights
Liver function abnormalities are common in congestive heart failure patients, often mild and not indicating liver disease. Reduced cardiac index and congestion contribute to these biochemical changes.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Congestive heart failure (CHF) can impact systemic hemodynamics.
- Liver function abnormalities are a potential complication of CHF.
Purpose of the Study:
- To investigate the incidence and severity of liver function abnormalities in patients with CHF.
- To correlate these abnormalities with hemodynamic parameters.
Main Methods:
- Analysis of systemic hemodynamics and biochemical profiles in 133 CHF patients.
- Patients categorized into three groups based on cardiac index (CI) severity.
- Linear regression analysis to assess correlations between pressures, CI, and liver function.
Main Results:
- Mild liver function test elevations (alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin) and decreased albumin observed in mild to moderate CHF groups.
- Severe CHF group (CI ≤ 1.5 L/min/m²) showed significantly elevated aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and total bilirubin.
- Abnormalities in liver function tests ranged from 27% to 80% in the severe CHF group.
- Hemodynamic parameters (right atrial pressure, pulmonary wedge pressure, CI) correlated with liver function abnormalities, but with small coefficients.
Conclusions:
- Liver function abnormalities are common in CHF patients.
- These abnormalities are generally mild and not indicative of clinically apparent hepatic disease.
- Reduced forward flow and passive backward congestion are likely contributors to biochemical changes, with potential non-hemodynamic factors also involved.
Abstract:
To characterize the incidence and severity of liver function abnormalities in patients with congestive heart failure, we analyzed systemic hemodynamics and biochemical profiles in 133 patients with stable chronic congestive heart failure, secondary to a dilated cardiomyopathy. The patients were divided into three groups, based on the severity of the reduction in cardiac index (CI). The mean values of all liver function tests in groups 1 (n = 43; CI greater than or equal to 2.0 L/min/m2) and 2 (n = 48; CI greater than 1.5 and less than 2.0 L/min/m2) were essentially normal, except for minimally elevated alkaline phosphatase levels and slightly decreased albumin levels in both groups, and slight increases in levels of gamma-glutamyl transpeptidase and total bilirubin in group 2. In contrast, group 3 patients (n = 42; CI less than or equal to 1.5 L/min/m2) had the most severe heart failure, as assessed by the lowest CI and highest cardiac filling pressures, and significantly higher levels of aspartate aminotransferase (65 +/- 82 U/L), alanine aminotransferase (77 +/- 102 U/L), lactate dehydrogenase (282 +/- 91 U/L), and total bilirubin (29 +/- 14 mumol/L [1.7 +/- 0.8 mg/dL]). The percentage of patients in group 3 with these abnormalities ranged between 27% and 80%. Although linear regression analysis showed that the elevations in right atrial and pulmonary wedge pressures, and the decreases in CI, were significantly correlated with liver function abnormalities, the correlation coefficients were small. Thus, liver function abnormalities remain common in patients with congestive heart failure but are generally small in magnitude and not associated with clinically apparent hepatic disease. It is likely that reduced forward flow and passive backward congestion are both contributing factors in the pathogenesis of these biochemical abnormalities, although nonhemodynamic factors may also be important.