Journal
JOURNAL OF CARDIAC FAILURE
Volume 16, Issue 1, Pages 84-90Publisher
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.cardfail.2009.08.002
Keywords
Heart failure; abnormal liver function; hemodynamics; prognosis
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Funding
- Netherlands Heart Foundation [2006B157, 2006T37, D97-017]
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Background: We studied the relation between liver function abnormalities and hemodynamic profile in patients with heart failure (HF). Methods and Results: in 323 HF patients, liver function was determined by aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase, and direct and total bilirubin (Bili dir, Bili tot). Central venous pressure (CVP) and cardiac index (CI) were determined invasively. Follow-up consisted of time to all-cause mortality. Mean age was 53 +/- 15 Years, and 60% were male. In multivariable analysis, all liver function tests related to CVP, but higher CVP was predominantly related to GGT (r = 0.336, P < .001) and Bili dir (r = 0.370, P < .001). Only elevated AST (r = -0.177, P < .01), ALT (r = -0.130, P < .05), and Bill tot (r = -0.158, P < .01) were associated with both low CI and elevated CVP. The prognostic value of abnormal liver function tests was related to their interaction with CI and CVP. Conclusions: Elevated liver function tests mainly indicate higher CVP, whereas only the presence of elevated AST. ALT, or Bili dir may indicate a low Cl. The absence of prognostic information in the presence of invasive hemodynamic measurements suggests that abnormal liver function tests in HF reflect a poor hemodynamic status. (J Cardiac Fail 2010:16:84-90)
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