Liver Fibrosis Predicts Mortality in Heart Failure Patients With Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) has several pathophysiological aspects including stiffness of multiple organs. According to recent research, liver stiffness assessed by transient elastography predicts adverse prognosis in heart failure patients. Liver fibrosis can be assessed by nonalcoholic fatty liver disease (NAFLD) fibrosis score (−1.675 + 0.037 × age [years] + 0.094 × body mass index + 1.13 × diabetes mellitus [if presence, given 1] + 0.95 × AST [IU/L]/ALT [IU/L] − 0.013 × platelet count [10⁻⁹/L] − 0.66 × albumin [g/dL]) in patients with NAFLD. We aimed to investigate the impact of NAFLD fibrosis score (NFS) on prognosis of HFpEF patients. Methods and Results: We analyzed consecutive 492 patients with HFpEF who admitted to our hospital without chronic liver disease. These patients were divided into 4 groups based on the NFS: 1st (NFS < −1.12, n = 123), 2nd (−1.13 < NFS < 0.19, n = 123), 3rd (0.20 < NFS < 1.55, n = 123) and 4th (1.56 < NFS, n = 123) quartiles. In the follow-up period (mean 1107 days), 93 deaths (33 cardiac and 60 non-cardiac deaths) occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from 1st to 2nd, 3rd and 4th groups (8.1%, 12.2%, 23.6% and 31.7%, log rank P < .001). In the Cox proportional hazard analysis, after adjusting for potential confounding factors, NFS was an independent predictor of all-cause mortality in HFpEF patients (hazard ratio 1.98, 95% confidence interval 1.43–3.19, P < .001). Conclusion: NAFLD fibrosis score, a marker of liver fibrosis, can identify high risk patients with HFpEF.