Abstract
Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.
Highlights
Cardiac failure has a negative impact on the function of all parenchymatous organs, based both on the low organ perfusion in the left-sided forward failure and on the venous congestion in the right-sided backward failure[1]
Clinical correlations of abnormal liver function tests (LFTs) in acute heart failure (AHF) Concerning the distribution of LFTs elevations, the highest levels were seen in patients with acute coronary syndromes that had significantly higher transaminases (AST and Alanine aminotransferase (ALT)), while AHF patients without acute coronary syndromes had significantly higher cholestatic enzymes (T-BIL, GGT and alkaline phosphatase (ALP)) – all P
LFTs abnormalities were strongly associated with AHF severity and clinical manifestation
Summary
Cardiac failure has a negative impact on the function of all parenchymatous organs, based both on the low organ perfusion in the left-sided forward failure and on the venous congestion in the right-sided backward failure[1]. Most of the studies have been focused on cardiorenal syndromes, the impact of cardiac failure on liver function is considerable[2,3]. Common histopatological findings of hepatic impairment caused by heart failure embrace inflammatory changes, sinusoidal dilatation, necrosis and fibrosis – all these features occur both in centrilobular and periportal location. While stage of fibrosis has been described mostly in chronic right-sided heart failure, centrilobular or periportal necrosis have mainly been seen in acute heart failure (AHF) patients (Fig. 1) (ref.[4,5]). Current studies dealing with cardiac hepatopathy focus predominantly on the liver enzyme changes by analysing clinical and prognostic relevance of liver function tests (LFTs) abnormalities in patients with chronic heart failure. There are only few works investigating the liver involvement in AHF (Table 1) (ref.[6,7,8,9,10,11,12,13,14])
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