TY - JOUR

T1 - Relationship between invasive hemodynamics and liver function in advanced heart failure

AU - Vishram-Nielsen, Julie K K

AU - Deis, Tania

AU - Balling, Louise

AU - Sabbah, Muhammad

AU - Boesgaard, Søren

AU - Rossing, Kasper

AU - Wolsk, Emil

AU - Gustafsson, Finn

PY - 2019

Y1 - 2019

N2 - Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (β = 0.031, p = .0002), bilirubin (β = 0.027, p = .004), and INR (β = 0.013, p = .002). PCWP (β = 0.020, p = .002) and CI (β = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (β = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.

AB - Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (β = 0.031, p = .0002), bilirubin (β = 0.027, p = .004), and INR (β = 0.013, p = .002). PCWP (β = 0.020, p = .002) and CI (β = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (β = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.

KW - Adult

KW - Arterial Pressure

KW - Bilirubin/blood

KW - Biomarkers/blood

KW - Cardiac Output

KW - Catheterization, Swan-Ganz

KW - Central Venous Pressure

KW - Cross-Sectional Studies

KW - Female

KW - Heart Failure/blood

KW - Hemodynamics

KW - Humans

KW - International Normalized Ratio

KW - Liver/metabolism

KW - Liver Function Tests

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Pulmonary Wedge Pressure

KW - Retrospective Studies

KW - Serum Albumin, Human/metabolism

KW - Time Factors

U2 - 10.1080/14017431.2019.1646972

DO - 10.1080/14017431.2019.1646972

M3 - Journal article

C2 - 31327253

VL - 53

SP - 235

EP - 246

JO - Scandinavian Cardiovascular Journal

JF - Scandinavian Cardiovascular Journal

SN - 1401-7458

IS - 5

ER -