BPS 02–17 PREVALENCE, ASSOCIATIONS AND PROGNOSIS OF DIFFERENT PATTERNS OF CARDIOHEPATIC SYNDROME IN ACUTE DECOMPENSATED HEART FAILURE

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Abstract

Objective:

Over the last several years different mechanisms of cardiohepatic syndrome (CHS) in acute decompensated heart failure (ADHF) have been discussed. The purpose of the study was to assess the prevalence and associations of different patterns of CHS in ADHF.

Design and Method:

In 322 ADHF patients (190 male, 69.5 ± 10.7 years (M ± SD), arterial hypertension 87%, myocardial infarction 57%, atrial fibrillation 66%, diabetes mellitus 42%, known chronic kidney disease 39%, chronic anaemia 29%, ejection fraction (EF)38 ± 13%, EF<35%-39%) liver function tests (LFT)-alanine transaminase (ALT), aspartate transaminase (AST), direct and total bilirubin (DB and TB), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT) were measured on admission. LFTs were considered abnormal when levels exceeded local upper normal limit. Only ALTand/orAST increase was considered as hepatocellular CHS. Isolated increase of GGT, AP, DB and TB (with DB increase)–as cholestatic CHS. The simultaneous increase of markers of cytolysis and cholestasis was considered as mixed CHS. Mann-Whitney test, p < 0.05 was considered statistically significant.

Results:

Abnormal LFT occurred in 274 (85.1%) of patients. Hepatocellular, cholestatic and mixed pattern of CHS was detected in 0.4, 32.8 and 66.8% of patients with ADHF. In patients with mixed CHS vs hepatocellular and cholestatic CHS mean values of LFTs were higher - AST (32 (23;49) vs 21 (18;27)U/l,), ALT (30 (15;53) vs 17 (12;25)U/l), DB (12 (7;17) vs 6 (4;9) mcmol/l,), TB (33 (25;41) vs 19 (15;22) mcmol/l), p < 0.001 for all comparisons. Patients with mixed CHS comparing with cholestatic pattern had higher NT-proBNP (9200 ± 7985 vs 7122 ± 6572pg/ml, p < 0.05), incidence of EF < 35%(47 vs 36%, p < 0.05), severe mitral regurgitation (51 vs 31%, p < 0.01), prevalence of vasopressor therapy (11 and 4%, p < 0, 05), higher diameters of left (5.4 ± 1.1 vs 5.0 ± 0.9 sm, p < 0.01) and right atrial (6.7 ± 1.5 vs 6.1 ± 1.3 sm, p < 0.001), lower systolic blood pressure (132 ± 17 vs 144 ± 21 mmHg, p < 0.001) and pulse pressure (51 ± 14 vs 60 ± 15 mmHg, p < 0.001)on admission. Patients with mixed CHS comparing with cholestatic CHS had no significant differences in signs of congestion. Mixed CHS was associated with higher all-cause death in 6 months (30 vs 23%, p < 0,05).

Conclusions:

Abnormal LFTs occurred in 85.1% of patients. The prevalence of hepatocellular, cholestatic and mixed pattern was 0.4,32.8 and 66.8%. Patients with mixed compared with cholestatic CHS had higher incidence of hypoperfusion and worse prognosis.

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