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

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)