Abnormal Liver Function in Relation to Hemodynamic Profile in Heart Failure Patients

van Deursen, V.M.; Damman, K.; Hillege, H.L.; van Beek, A.P.; van Veldhuisen, D.J.; Voors, A.A.

doi:10.1016/j.cardfail.2009.08.002

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 1 , Pages 84-90, January 2010

Abnormal Liver Function in Relation to Hemodynamic Profile in Heart Failure Patients

V.M. van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
K. Damman, MD, PhD
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
H.L. Hillege, MD, PhD
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
A.P. van Beek, MD, PhD
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
D.J. van Veldhuisen, MD, PhD
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
A.A. Voors, MD, PhD
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Reprint requests: A.A. Voors, MD, PhD, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. Tel: (+31) 503612355.

Received 7 May 2009; received in revised form 10 June 2009; accepted 3 August 2009. published online 27 September 2009.

Abstract

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, γ-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 Bili 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 CI. 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.

Key Words: Heart failure, abnormal liver function, hemodynamics, prognosis

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The authors have no conflicts of interest.

K. Damman is supported by the Netherlands Heart Foundation (grant 2006B157). A.A. Voors and D.J. van Veldhuisen are Clinical Established Investigators of the Netherlands Heart Foundation (grants 2006T37 and D97-017, respectively).

PII: S1071-9164(09)00957-9

doi:10.1016/j.cardfail.2009.08.002

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 1 , Pages 84-90, January 2010

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