Abstract
Background: Liver dysfunction due to heart failure (HF) is often referred as cardiac or congestive hepatopathy. FIB4 index (age [years] х aspartate aminotransferase [IU/L] / platelet count [10 -9 /L] х radical alanine aminotransferase [IU/L]) is expected to be useful for evaluating liver fibrosis in patients with nonalcoholic fatty liver disease. It has been recently reported that liver stiffness assessed by transient elastography predicts adverse prognosis in HF patients. We aimed to investigate the impact of FIB4 index on prognosis of HF and compare the underlying cardiac function. Methods and Results: We analyzed 1268 HF patients who admitted to our hospital. Out of these patients, patients with hepatitis and chronic liver disease were excluded, and 1058 patients were finally analyzed. These patients were divided into 3 groups based on the FIB4 index: 1st, 2nd and 3rd tertile (n=353, each). In the follow-up period (mean 1047 days), 246 deaths (122 cardiac deaths and 124 non-cardiac deaths) occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from 1 st to 2 nd and 3 rd groups (12.2, 21.0 and 36.6%, P <0.001). In the Cox proportional hazard analysis, FIB4 index was an independent predictor of all-cause mortality in HF patients (hazard ratio 1.79, 95% confidence interval 1.29-2.49, P<0.001). In addition, we compared echocardiographic findings among the three groups. Left ventricular ejection fraction and right ventricular fractional area change did not differ among three groups. In contrast, the 3rd tertile, compared to 2nd and 1st tertiles, had higher levels of left atrial volume (92.5 vs. 82.8, and 74.9 ml, P < 0.01), mitral valve E/e’ (16.6 vs. 15.3, and 13.8, P < 0.01), inferior vena cava diameter (16.2 vs. 14.5, and 14.4 mm, P < 0.01) and right atrial area (20.9 vs. 17.4, and 17.6 cm 2 , P < 0.01). Conclusion: FIB4 index, a marker of liver stiffness, is associated with larger right and left heart volume overload, and higher mortality in HF.
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