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PROGNOSTIC VALUE OF LIVER FUNCTION TEST ABNORMALITIES IN PATIENTS WITH HEART FAILURE
A739 JACC April 1, 2014 Volume 63, Issue 12
Heart Failure and Cardiomyopathies Prognostic Value of Liver Function Test Abnormalities in Patients with Heart Failure Oral Contributions Room 204 B Saturday, March 29, 2014, 9:15 a.m.-9:30 a.m.
Session Title: Prognostic and Diagnostic Role of Biomarkers in Heart Failure Abstract Category: 12. Heart Failure and Cardiomyopathies: Clinical Presentation Number: 904-08 Authors: Andrew Patrick Ambrosy, Timothy P. Dunn, Paul Heidenreich, Stanford University School of Medicine, Stanford, CA, USA, VA Palo Alto Health Care System, Palo Alto, CA, USA Background: Liver function test (LFT) abnormalities are often observed in patients with heart failure. However, the relationship of LFTs with outcomes is not well described. Methods: Patients of the VA Palo Alto Health Care System (3 inpatient facilities, 7 community clinics) with a complete set of LFTs in the 60 days prior to a first HF diagnosis were included in the analysis from 2005 to April 2013. LFTs included albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (AP), and total bilirubin (T Bili). Proportional hazards analysis evaluated the association between quintiles of LFT and total mortality adjusting for other LFTs, age, gender, race, ejection fraction, comorbidities, renal function, sodium, hemoglobin, and natriuretic peptide. Results: A total of 2096 patients met inclusion criteria. Patients were a mean of 71+12 years old, 97% were male, and 57% had a prior diagnosis of ischemic heart disease. The median (25th, 75th) and % abnormal values were Alb 3.6 (3.3, 3.9) g/dl 23% (abnormally low), ALT 21 (16, 30) IU/L 8%, AST 24 (20,31) IU/L 11%, AP 70 (57, 87) IU/L 10%, and T Bili 0.8 (0.6, 1.0) mg/dl 12%. There were 851 deaths (41%) over a mean duration of 41+27 months. Mortality increased with lower values of Alb and ALT and higher levels of AST and AP (Table 1). The association with T Bili was not significant. Conclusion: Many LFT values in the “normal” range are independently associated with decreased survival beyond traditional risk factors for mortality in heart failure.
Heart Failure and Cardiomyopathies Prognostic Value of Liver Function Test Abnormalities in Patients with Heart Failure Oral Contributions Room 204 B Saturday, March 29, 2014, 9:15 a.m.-9:30 a.m.
Session Title: Prognostic and Diagnostic Role of Biomarkers in Heart Failure Abstract Category: 12. Heart Failure and Cardiomyopathies: Clinical Presentation Number: 904-08 Authors: Andrew Patrick Ambrosy, Timothy P. Dunn, Paul Heidenreich, Stanford University School of Medicine, Stanford, CA, USA, VA Palo Alto Health Care System, Palo Alto, CA, USA Background: Liver function test (LFT) abnormalities are often observed in patients with heart failure. However, the relationship of LFTs with outcomes is not well described. Methods: Patients of the VA Palo Alto Health Care System (3 inpatient facilities, 7 community clinics) with a complete set of LFTs in the 60 days prior to a first HF diagnosis were included in the analysis from 2005 to April 2013. LFTs included albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (AP), and total bilirubin (T Bili). Proportional hazards analysis evaluated the association between quintiles of LFT and total mortality adjusting for other LFTs, age, gender, race, ejection fraction, comorbidities, renal function, sodium, hemoglobin, and natriuretic peptide. Results: A total of 2096 patients met inclusion criteria. Patients were a mean of 71+12 years old, 97% were male, and 57% had a prior diagnosis of ischemic heart disease. The median (25th, 75th) and % abnormal values were Alb 3.6 (3.3, 3.9) g/dl 23% (abnormally low), ALT 21 (16, 30) IU/L 8%, AST 24 (20,31) IU/L 11%, AP 70 (57, 87) IU/L 10%, and T Bili 0.8 (0.6, 1.0) mg/dl 12%. There were 851 deaths (41%) over a mean duration of 41+27 months. Mortality increased with lower values of Alb and ALT and higher levels of AST and AP (Table 1). The association with T Bili was not significant. Conclusion: Many LFT values in the “normal” range are independently associated with decreased survival beyond traditional risk factors for mortality in heart failure.