Outcomes In Advance Heart Failure Patients With Biopsy Proven Liver Fibrosis

Abstract

<h3>Background</h3> There is paucity of data regarding outcomes of stage D heart failure patients undergoing evaluation and treatment with advanced therapies [heart transplant (HTX), left ventricular assist device (LVAD)] in the setting of biopsy-proven liver fibrosis. <h3>Methods</h3> We retrospectively assessed stage D heart failure patients (age>18 years) who had liver biopsy and underwent advanced therapy evaluation from 2017 to 2020. Overall baseline characteristics and 1-year clinical outcomes were compared between mild to moderate (stage 0-2) and severe liver fibrosis (stage 3-4) group. <h3>Results</h3> A total of 136 patients were included. HTX was done in 23 patients, LVAD in 48 patients and 65 did not undergo advance therapies (no therapy group). Patients in no therapy group were older (61 vs 55 vs 57 years; p=0.03) and had more diabetes (60% vs 26% vs 46%; p=0.02) in comparison to HTX and LVAD group, respectively. Whereas HTX group had more non-ischemic cardiomyopathy (83% vs 65% vs 43%; p=0.02) compared to LVAD and no therapy group, respectively (Table 1A). Steatohepatitis was present in 26.1% of HTX, 31.3% of LVAD and 32.3% in no therapy group. Biopsies identified 23 patients with severe liver fibrosis and 113 patients with mild to moderate fibrosis. 1 LVAD patient lost follow-up in mild to moderate fibrosis group. Out of 23 patients in severe fibrosis group, 65% underwent no advanced therapies, only 4% underwent HTX and 30% received LVAD (Table1B). Among patients in the no therapy group, mean PCWP was higher in fibrosis grade 3-4 when compared to fibrosis grade 0-2 group (23 vs 17, p=0.04). No patient died in heart transplant group. There was no significant difference in 1-year mortality in LVAD group (43% vs 20%, p=0.2), whereas no therapy group showed high mortality (60% vs 26%, p=0.02) in severe fibrosis vs mild-moderate fibrosis patients (Tabe1B). The overall 1-year mortality among severe liver fibrosis patients who underwent no advanced therapy was 60% vs 37.5% with advanced therapies. <h3>Conclusions</h3> Liver fibrosis is common among advanced heart failure patients. Mortality is high in end-stage heart failure patients with underlying severe liver fibrosis. As anticipated, patients with severe liver fibrosis were less likely to undergo LVAD or HTX than patients with mild to moderate fibrosis. Therefore, liver biopsy should be considered in patients being evaluated for advanced therapies.