Abstract 9562: Liver Dysfunction Assessed by Model of End-stage Liver Disease Excluding INR (MELD-XI) Scoring System Predicts Adverse Prognosis in Heart Failure

Abstract

Background: Liver dysfunction due to end-stage heart failure (HF) is often referred as cardiac or congestive hepatopathy. The composite Model for End-Stage Liver Disease excluding INR (MELD-XI) is a robust scoring system of liver function, and a high score is associated with poor prognosis in heart transplant recipients. However, the impact of MELD-XI scores on cardiac function and prognosis in general HF patients still remains unclear. Methods and Results: We retrospectively analyzed 550 patients with HF who admitted to our hospital. Liver function was estimated by MELD-XI formula (5.11хlog (bilirubin)+ 11.76хlog (creatinine)+9.44). These patients were divided into two groups based on the median MELD-XI score: Group L (MELD-XI <10, n=269) and Group H (MELD-XI ≥10, n=281). We compared echocardiographic findings and cardiac event rates including cardiac deaths and re-hospitalization due to worsening HF between two groups. In echocardiographic paremeters, left atrial volume (LAV), right atrial area (RAA), right ventricular diastolic area (RVAd), right ventricular systolic area (RVAs), inferior vena cava diameter (IVC) were higher, and left ventricular ejection fraction (LVEF) was lower in group H than in group L (LAV: 93.7 vs. 74.0 ml, RAA: 25.0 vs. 16.5 cm 2 , RVAd: 17.1 vs. 15.7 cm 2 , RVAs: 10.6 vs. 9.1 cm 2 , IVC: 15.9 vs. 14.4 mm, LVEF: 45.5 vs. 50.4%, P<0.05, respectively). Right ventricular fractional area change did not differ between 2 groups. In addition, 151 events (52 deaths and 99 re-hospitalizations) occurred during the follow-up period (mean 348 days). Importantly, the event-free rate was significantly higher in group L than in group H (78.4% vs. 66.9%, logrank P =0.001). In the Cox proportional hazard analysis, higher MELD-XI (MELD-XI ≥10) was an independent predictor of cardiac events in HF patients (hazard ratio 1.79, 95% confidence interval 1.29-2.49, P=0.001). Conclusions: A MELD-XI scoring system, a marker of liver function, can identify high risk patients associated with larger right heart volume overload, left ventricular systolic dysfunction, and adverse clinical outcomes in HF.