Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.
Department of Medicine, University of Copenhagen , Copenhagen , Denmark.
Scand Cardiovasc J. 2019 Oct;53(5):235-246. doi: 10.1080/14017431.2019.1646972. Epub 2019 Jul 30.
. 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. . 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. . 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 ( = 0.031, = .0002), bilirubin ( = 0.027, = .004), and INR ( = 0.013, = .002). PCWP ( = 0.020, = .002) and CI ( = -0.17, = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP ( = 1.496, = .005). . 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.
. 探讨在接受最大耐受的心力衰竭药物治疗的晚期心力衰竭（AHF）患者中，肝功能（LF）与侵入性血流动力学的横断面和纵向关系。. 这是一项回顾性研究，共纳入 309 例左心室射血分数<45%、接受最大耐受的心力衰竭药物治疗并接受 AHF 治疗的 AHF 连续患者。所有患者均接受 Swan-Ganz 导管进行右心导管检查（RHC）。使用热稀释法测量心输出量。获得肺毛细血管楔压（PCWP）、中心静脉压（CVP）、心指数（CI）和平均动脉压（MAP）的测量值。在 33 例患者中重复进行 RHC 和 LF 评估（中位数（IQR）=186.5（150-208）天）。. 平均（SD）年龄为 50（±13）岁，239 例（77%）为男性。仅有 22 例（7%）接受了正性肌力药物治疗，无一例接受机械循环支持。中位（IQR）血浆丙氨酸转氨酶（ALT）为 32（22-53）U/L，碱性磷酸酶（ALP）为 82（63-122）U/L，胆红素为 14（9-22）μmol/L，白蛋白为 39（35-43）g/L，乳酸脱氢酶为 212（175-275）U/L，凝血酶原时间/国际标准化比值（PT/INR）为 1.1（1.0-1.3）。多变量分析显示，CVP 与 LF 检查之间存在显著相关性：ALP（ = 0.031， = .0002）、胆红素（ = 0.027， = .004）和 INR（ = 0.013， = .002）。PCWP（ = 0.020， = .002）和 CI（ = -0.17， = .005）也与胆红素相关。随着时间的推移，胆红素的变化与 CVP 的变化呈正相关（ = 1.496， = .005）。. 在接受最佳治疗的 AHF 患者中，CVP 与胆汁排泄和肝脏合成功能的标志物均有关，而 CVP 的变化与胆汁排泄的标志物有关。充血的缓解可能会改善 AHF 患者的 LF 指标。
