Abstract
Previous studies suggested an association between heart failure (HF) and hepatic disorders. Liver function parameters have been shown to predict outcome in HF with reduced ejection fraction, but their impact in HF with preserved ejection fraction (HFpEF) has not yet been investigated. Between January 2011 and February 2017, 274 patients with confirmed HFpEF were enrolled (age 71.3 ± 8.4 years, 69.3% female) in a prospective registry. During a median follow-up of 21.5 ± 18.6 months, 97 patients (35.4%) reached the combined endpoint defined as hospitalization due to HF and/ or death from any cause. By multivariable cox regression, serum gamma-glutamyltransferase (GT) was independently associated with outcome (Hazard Ratio (HR) 1.002, p = 0.004) along with N-terminal pro brain natriuretic peptide (HR 2.213, p = 0.001) and hemoglobin (HR 0.840, p = 0.006). Kaplan-Meier analysis showed that patients with serum gamma-GT levels above a median of 36 U/L had significantly more events as compared to the remainder of the group (log-rank p = 0.012). By multivariable logistic regression, higher early mitral inflow velocity/ mitral peak velocity of late filling (Odds Ratio (OR) 2.173, p = 0.024), higher right atrial (RA) pressure (OR 1.139, p < 0.001) and larger RA diameter (OR 1.070, p = 0.001) were independently associated with serum gamma-GT > 36 U/L. Serum levels of gamma-GT are associated with both left and right-sided cardiac alterations and may serve as a simple tool for risk prediction in HFpEF, especially when further diagnostic modalities are not available.
Highlights
IntroductionIn the SURVIVE study observing ADHF patients elevated transaminases were found in 46% of patients - and were associated with a 2-fold increase in 31-day mortality[14]
Outcome[9,10,11,12,13,14,15]
After 21.5 ± 18.6 months of follow-up, 97 patients (35.4%) reached the combined endpoint. These patients presented with higher New York Heart Association (NYHA) functional class (p < 0.001) at baseline, had more prior heart failure (HF) hospitalizations (p < 0.001), more frequently suffered from atrial fibrillation (p = 0.022), diabetes (p = 0.028) and chronic obstructive pulmonary disease (p = 0.016) and had a higher intake of diuretics (p = 0.006) compared with the remainder of the group (n = 177)
Summary
In the SURVIVE study observing ADHF patients elevated transaminases were found in 46% of patients - and were associated with a 2-fold increase in 31-day mortality[14]. In the EFICA trial studying patients with cardiogenic shock elevations in transaminases were an independent predictor of 4-week mortality[15]. There is some evidence that non-alcoholic fatty liver disease (NAFLD) is associated with LV diastolic dysfunction in patients with diabetes[21], the prognostic role of liver enzymes in HFpEF as well as their pathophysiological correlates have not been investigated so far. The aim of this study was to describe the association of commonly assessed liver enzymes with clinical outcome in patients with HFpEF. We sought to identify alterations of cardiac structure and function that may underlie deviations of liver function parameters
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