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The Relationship between the Presence of Cardiohepatic Syndrome and Mortality in Heart Failure with Reduced Ejection
Mustafa Azmi Sungur1, Aylin Sungur2, Aycan Esen Zencirci1
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Insights
Cardiohepatic syndrome (CHS) significantly increases long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF). This easily assessed condition from routine labs aids in predicting patient outcomes.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Heart failure (HF) commonly impairs liver function, leading to the definition of cardiohepatic syndrome (CHS).
- CHS describes the complex interplay between cardiac and hepatic health.
Purpose of the Study:
- To investigate the impact of CHS on long-term mortality in patients diagnosed with heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- Retrospective analysis of HFrEF patients (2010-2018) from an outpatient HF clinic.
- CHS defined by elevated cholestasis parameters (bilirubin, alkaline phosphatase, GGT).
- Comparison of mortality between CHS (+) and CHS (-) groups, with a median follow-up of 4.4 years.
Main Results:
- 22.4% of 469 HFrEF patients had CHS, presenting with older age and more comorbidities.
- CHS group showed significantly worse ventricular function and higher all-cause mortality (61.9% vs. 19.5%).
- Multivariate analysis identified CHS as an independent predictor of long-term mortality (HR: 2.92).
Conclusions:
- CHS presence is linked to elevated long-term mortality in HFrEF outpatients.
- CHS, assessed via routine labs, can serve as a valuable prognostic tool for HFrEF patients.
Objective:
Heart failure (HF) is a major health burden that commonly affects liver function. Therefore, cardiohepatic syndrome (CHS) has been defined to describe the relationship between the heart and the liver. In this study, we aimed to evaluate the effect of CHS on long-term mortality in HF with reduced ejection fraction (HFrEF).
Methods:
Patients followed at the outpatient HF clinic of our hospital with HFrEF between 2010 and 2018 were retrospectively analyzed. CHS was defined as elevation of at least two of three cholestasis parameters (total bilirubin, alkaline phosphatase, and gamma-glutamyl transferase) above the upper limit of normal. Patients were divided into two groups according to the presence of CHS. The endpoint was all-cause mortality. Patients were followed up for a median of 4.4 (3.3-5.9) years.
Results:
A total of 469 patients were included in the study. The mean age of the group was 52.2 ± 11.9 years and 75.5% of the patients were males. About 22.4% (n = 105) of the patients had CHS. Patients with CHS were older and had more comorbidities than patients without CHS. Furthermore, significantly worse left and right ventricular functions were observed in CHS (+) group. All-cause mortality was significantly higher in CHS (+) group (61.9% vs. 19.5%, P < 0.001). Multivariate analysis revealed the presence of CHS (HR: 2.92, 95% CI: 2.09-4.07, P < 0.001) as an independent predictor of long-term mortality.
Conclusion:
The presence of CHS is associated with increased long-term mortality in outpatients with HFrEF. As an easy parameter to assess from routine laboratory parameters, CHS should be used to evaluate the long-term prognosis of patients with HFrEF.
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