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Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance
Author(s) -
Poelzl Gerhard,
Ess Michael,
MussnerSeeber Christine,
Pachinger Otmar,
Frick Matthias,
Ulmer Hanno
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02573.x
Subject(s) - medicine , heart failure , hazard ratio , proportional hazards model , liver transplantation , gastroenterology , clinical endpoint , liver function tests , heart transplantation , clinical significance , cardiology , transplantation , confidence interval , clinical trial
Eur J Clin Invest 2011 Abstract Background Although abnormal liver morphology and function have long been recognized, characterization and importance of liver dysfunction in heart failure are poorly defined. This study sought to investigate the relevance of circulating liver function tests (LFTs) in an unselected chronic heart failure (CHF) cohort. Materials and methods A total of 1032 consecutive ambulatory patients with CHF were enrolled from 2000 to 2008. Clinical and laboratory variables including LFTs were collected at study entry. Follow‐up (median 36 months) was available in 1002 (97·1%) patients. The endpoint was defined as death from any cause or heart transplantation. Hazard ratios (HR) for transplant‐free survival were estimated per log unit using Cox proportional hazard regression models for sex‐stratified data. Results Sex‐specific prevalence of cholestatic enzyme elevation was 19·2% as opposed to elevated transaminases in 8·3%. Cholestatic enzymes, but not transaminases, were significantly associated with severity of heart failure syndrome and backward failure. The endpoint was recorded in 339 patients (33·8%). T‐Bil, γ‐glutamyltransferase (GGT) and alkaline phosphatase (ALP) were associated with adverse outcome in bivariate models. Of these, GGT [HR 1·22 (1·06, 1·41); P = 0·006] and ALP [HR 1·52 (1·09, 2·12); P = 0·014] were independently associated with the endpoint after adjustment for a wide array of clinical and laboratory predictors. Conclusions Liver dysfunction is frequent in CHF and characterized by a predominantly cholestatic enzyme profile that is associated with disease severity and prognosis. Thus, we propose a cardio‐hepatic syndrome in CHF. Future studies are needed to clarify the exact mechanisms of organ interaction.