Alterations in indices of liver function in congestive heart failure with particular reference to serum enzymes

Abstract

Serial liver function tests were performed in 175 patients with right-sided heart failure of diverse etiology. The cases were classified as acute or chronic depending on the duration and severity of congestive failure. The indices of liver function studied and the incidence of abnormal values obtained were as follow. Excretory function: serum bilirubin (31 per cent), bromsulfalein retention (80 per cent), alkaline phosphatase (10 per cent). Parenchymal cell destruction: serum glutamic oxalacetic transaminase (33 per cent), serum glutamic pyruvic transaminase (11 per cent). Abnormal serum protein production: serum globulins (51 per cent), thymol turbidity (2 per cent). Biosynthetic functions: plasma prothrombin concentration (80 per cent), serum albumin (30 per cent), cephalin flocculation (19 per cent), cholinesterase activity (48 per cent), cholesterol (46 per cent), cholesterol esters (37 per cent). The causes of the right heart failure did not appear to influence the pattern of altered liver function as much as whether failure was acute or chronic. The liver indices reflecting parenchymal cell destruction and excretory activity were most affected during acute failure. Elevated levels of transaminase (up to 1,200 units) and bilirubin (up to 8 mg. per cent) were obtained in half of the patients with acute failure, in the absence of myocardial or pulmonary infarction. A much greater incidence of elevated transaminase levels was found in acute failure (49 per cent) than in chronic failure (5 per cent). These changes correlated with the presence of centrilobular hepatocellular necrosis. The majority of indices of hepatic function returned to normal within one to two weeks following cardiac compensation, except for those reflecting biosynthesis by the liver, which improved more slowly, and hyperglobulinemia, which tended to persist. Repeated attacks of failure (as in rheumatic heart disease) were associated with more severe impairment in liver function.