PP.22.15

Abstract

Objective: Recently the impact of acute decompensated heart failure (ADHF) on hepatic function has been described as cardio-hepatic syndrome. It is assumed that cytolysis is mainly associated with systemic hypoperfusion, whereas cholestasis - with volume overload. Systemic congestion is the known main driver for morbidity, mortality and hospital readmission of patients with ADHF. The aim of this study was to determine possible association of impaired liver function tests (LFT) with hydration status in patients with ADHF. Design and method: In 200 patients with ADHF (84 male, 72.9 ± 10.7 years(M ± SD), arterial hypertension 79%, myocardial infarction 43%, atrial fibrillation (AF) 62%, diabetes mellitus 36.5%, chronic kidney disease (CKD) 38%, anaemia 23.5%, chronic obstructive lung disease 23.5%, ejection fraction(EF) 45 ± 12%, EF < 35% 25%, chronic hepatic diseases 9.5%) alanine transaminase(ALT), aspartate transaminase(AST), total bilirubin, alkaline phosphatase (AP), gamma-glutamyl transpeptidase(GGT) were measured and hydration status by bioimpedance vector analysis (BIVA) was assessed using resistance(R) and reactance(Xc), standardized by height(h). LFTs were considered abnormal when levels exceeded local upper normal levels. Mann-Whitney and Spearman test were performed. P < 0.05 was considered statistically significant. Results: Increase of ALT and/or AST occurred in 29 (14.5%) patients (alone ALT/ alone AST/ both TA – in 42.3, 19.2, 38.5% respectively), increase of bilirubin,AP and GGT - in 68(34%), 14(7%), 20(10%) patients respectively. Patients with versus without transaminases increase had higher rate of signs of congestion: echo-hydropericardium (33 vs 12%, p < 0.01), radiological signs of hydrothorax (72 vs 32%, p < 0.001), jugular venous distension (55 vs 21%, p < 0.001). The patients with versus without increase of bilirubin demonstrated higher volume overload: lower levels of both R/h and Xc/h (218 ± 44 vs 238 ± 54 Om/m, p < 0.01 and 16 ± 7 vs 19 ± 8 Om/m, p < 0.01). Negative correlations between serum bilirubin and BIVA parameters of hyperhydration were revealed (r = −0.38 for R/h and r = −0.29 for Rx/h, p < 0.05). Conclusions: Impaired LFT were common in patients with ADHF and were associated with signs of congestion (hydropericardium, hydrothorax, jugular venous distension). Increase of bilirubin was associated with higher volume overload assessed by BIVA. The results of the study suggest that congestion may be important in the development of cardiohepatic syndrome in patients with ADHF.