Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure

Abstract

Aims. 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). Methods. 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. Results. 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. Conclusions. 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.

Severe Direct Hyperbilirubinemia as a Consequence of Right Heart Failure in Congenital Heart Disease

“…6 Adult studies further correlate the degree of TR with severity of cholestasis. 7,8 Elevated bilirubin has also been known to indicate ongoing right heart disease in the perioperative phase of left ventricular assist device placement and heart transplantation. 9,10 The increased filling pressures are transmitted to the venous system causing congestive hepatopathy.…”

Diagnosis and management of acute heart failure

“…Liver function abnormalities are detected in about 75% of AHF patients and are closely related to the severity of disease and clinical findings ( 35 ). In bilateral and right sided AHF, cholestatic type (total bilirubin, gamma glutamyl transferase, alkaline phosphatase) liver dysfunction is detected in patients with moderate-to-severe tricuspid insufficiency, whereas in left sided AHF and hypotension (SBP <100 mm Hg) transaminase elevation is present.…”

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

“…Previous studies have shown cholestatic pattern of LFT abnormality in patients with biventricular failure, congestive cardiac failure or in valvular abnormalities such as tricuspid regurgitation [16]. This can be explained by hepatic congestion due to increased venous pressure resulting in cholestasis and elevated ALP and Bilirubin.…”