[PP.14.10] TOTAL BILIRUBIN INCREASE IS ASSOCIATED WITH RIGHT- AND LEFT-SIDE HEART FAILURE

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Abstract

Objective:

Elevated total bilirubin (TB) is frequently reported in patients with heart failure and associated with worse prognosis. It is presumed that TB increase is related with predominantly right-heart dysfunction and congestion. We aimed to characterize TB increase in patients with acute decompensated heart failure (ADHF), as it is commonly encountered yet poorly defined.

Design and method:

In 322 patients with ADHF (190 male, 69.5 ± 10.7 years (M ± SD), arterial hypertension 87%, myocardial infarction 56.5%, atrial fibrillation 65.5%, diabetes mellitus 41.6%, known chronic kidney disease 39.1%, chronic anaemia 29.2%, ejection fraction (EF) 37.6 ± 12.6%, EF <35% 39.1%) TB was measured on admission. TB increase was considered when serum level exceeded local upper normal limit. Mann-Whitney test was performed. P < 0.05 was considered statistically significant.

Results:

Increase of TB occurred in 232 (72%) patients. Mean value of TB was 26.3 ± 14.5 μmol/l. Patients with versus without TB increase had higher levels of NT-proBNP (9510 ± 8046 vs 6102 ± 5607 pg/ml, p < 0,01), higher right ventricular diameter (36 ± 7 vs 32 ± 7 mm, p < 0.001), left ventricular end-diastolic volume (LV EDV) (59 ± 9 vs 55 ± 8 mm, p < 0.001), pulmonary artery pressure (47 ± 18 vs 59 ± 18 mmHg, p < 0.001), heart rate (103 ± 29 vs 97 ± 29, p < 0.05), lower LV ejection fraction (36 ± 13 vs 40 ± 11%, p < 0.01), systolic blood pressure (134 ± 19 vs 142 ± 17 mmHg, p < 0.001) and pulse pressure (52 ± 16 vs 59 ± 13 mmHg, p < 0.001), higher prevalence of severe mitral regurgitation (47 vs 36%, p < 0.05) and tricuspid regurgitation (72 vs 21%, p < 0.001). TB increase was associated with signs of right-heart dysfunction/congestion: jugular venous distension (44 vs 35%, p < 0.05), dilated inferior vena cava (77 vs 49%, p < 0.001) and portal vein (49 vs 26%, p < 0.05), echo-hydropericardium (30 vs 17%, p < 0.01), hydrothorax (48 vs 32%, p < 0.01), ascites (51 vs 21%, p < 0.001), hepatomegaly (79 vs 58%, p < 0.001) and with signs of left-heart dysfunction/hypoperfusion – EF < 35% (50 vs 24%, p < 0.001) and SBP < 110 mmHg on admission (14 vs 2%, p < 0.001).

Conclusions:

TB increase occurred in 72% of patients with ADHF. The predictors of TB increase were sings of right- and left-heart dysfunction.

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