Longitudinal Trends, Hemodynamic Profiles, and Prognostic Value of Abnormal Liver Function Tests in Patients With Acute Decompensated Heart Failure: An Analysis of the ESCAPE Trial

摘要

Most of what is understood about abnormal liver function tests (LFTs) in heart failure (HF) derives from the stable chronic HF patient population.1'2 Recent studies have analyzed abnormal LFTs in the acutely decompensated heart failure (ADHF) patient population. Abnormalities in LFTs are common, occurring in ~ 70% or more of these patients, and show a vastly different distribution than those in stable HF. Presently little is known about longitudinal trends of LFTs in patients admitted with and treated for ADHF.Abnormal LFTs in HF patients occur with 2 hemodynamic states. Decreased cardiac output leading to impaired organ perfusion is associated with acute centrilobular hepa-tocellular damage, ischemic hepatic injury, and necrosis. Additionally, elevated right atrial filling pressures may lead to congestive hepatic injury and a pathologic finding described as "nutmeg liver." There is growing evidence that individual biochemical markers correlate with various hemodynamic states and that the degree of hepatic injury depends on the contribution of congestion versus poor perfusion. There is substantial variability among studies, and it is still unclear if elevated liver enzymes in individuals with HF are surrogates of hemodynamics.