Echocardiographic Correlates of Abnormal Liver Tests in Patients with Exacerbation of Chronic Heart Failure

Abstract

Background: Elevated total bilirubin (TB) and transaminases are frequently reported in patients with heart failure and are related to their worse prognosis. On the basis of hemodynamic data from previous studies, the investigators hypothesized that elevated bilirubin and transaminases are associated with different patterns of cardiac remodeling and dysfunction in patients with heart failure (i.e., elevated bilirubin with predominantly right-heart dysfunction and elevated transaminases with predominantly left-heart dysfunction). Therefore, the aim of this study was to evaluate prospectively echocardiographic correlates of elevated TB and transaminases on admission in patients with exacerbation of chronic heart failure.

Methods: The following echocardiographic parameters were prospectively analyzed in 150 patients (mean age, 75 years; 59% men): right ventricular end-diastolic diameter, right atrial area, tricuspid regurgitation, right ventricular systolic pressure, tricuspid annular plane systolic excursion, tricuspid lateral annulus systolic velocity, estimated right atrial pressure, portal vein pulsatility index (PVPI), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction, and cardiac index.

Results: Elevated TB was found in 61 patients (41%) and elevated transaminases in 46 patients (31%). In univariate logistic regression analysis, right ventricular end-diastolic diameter, right atrial area, tricuspid regurgitation, estimated right atrial pressure, tricuspid annular plane systolic excursion, tricuspid lateral annulus systolic velocity, PVPI, left ventricular ejection fraction, and cardiac index were significant predictors of elevated TB (P < .05 for all). LVEDD indexed to body surface area, right ventricular end-diastolic diameter, and systolic blood pressure on admission were significant predictors of elevated transaminases (P < .05 for all). In a multivariate regression model, only PVPI remained a significant predictor of elevated TB and LVEDD indexed to body surface area of elevated transaminases. Sensitivity, specificity, and positive and negative predictive values of PVPI > 0.5 in the prediction of elevated TB were 81%, 87%, 82%, and 87%, respectively.

Conclusion: Several echocardiographic indices of right-heart dysfunction and low cardiac index are related to elevated TB, with an increased PVPI having the best predictive value. A weak statistically significant association was found between elevated transaminase levels and left ventricular end-diastolic diameter indexed to body surface area.

Keywords: Echocardiography; Heart failure; Portal vein; Total bilirubin; Transaminases.