Goyal Amandeep, Dalia Tarun, Ranka Sagar, Sauer Andrew J, Hu Jinxiang, Cernik Colin, Nuqali Abdulelah, Chandler Jonathan, Parimi Nikhil, Dennis Katie, Majmundar Monil, Tayeb Taher, Haglund Jennifer, Shah Zubair, Vidic Andrija, Gupta Bhanu, Haglund Nicholas A
Departments of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas.
Departments of Biostatistics and Data Science, The University of Kansas Health System, Kansas City, Kansas.
Am J Cardiol. 2023 May 1;194:46-55. doi: 10.1016/j.amjcard.2023.02.004. Epub 2023 Mar 20.
There is a paucity of data regarding the impact of liver fibrosis on patients with stage D heart failure (HF). We conducted a retrospective study (January 1, 2017 to December 12, 2020) in patients with stage D HF who underwent liver biopsy as part of their advanced HF therapy evaluation. Baseline characteristics and 1-year outcomes were compared between no- or mild-to-moderate-fibrosis (grade 0 to 2) and advanced-fibrosis (grade 3 to 4) groups. Of 519 patients with stage D HF, 136 who underwent liver biopsy (113 [83%] no or mild-to-moderate fibrosis and 23 [17%] advanced fibrosis) were included. A total of 71 patients (52%) received advanced HF therapies (23 heart transplantation, 48 left ventricular assist devices). One-year mortality was higher among patients with advanced fibrosis (52% vs 18%, p <0.001). Further subgroup analysis suggested a trend toward increased 1-year mortality among patients with advanced fibrosis who underwent advanced therapies (37% vs 13%, p = 0.09). There was a trend of lower likelihood of receiving advanced HF therapies in the advanced-fibrosis group, only 1 heart transplantation and 7 left ventricular assist devices, but it did not reach statistical significance (35% vs 56%, p = 0.06). After adjustment for confounders, degree of liver fibrosis was an independent predictor of mortality (odds ratio 6.2; 95% 1.27 to 30.29, p = 0.02). We conclude that advanced liver fibrosis is common among patients with stage D HF who undergo evaluation for advanced HF surgical therapies and significantly increases 1-year mortality. Further larger studies are needed to support our findings.
关于肝纤维化对D期心力衰竭（HF）患者的影响，目前数据匮乏。我们对2017年1月1日至2020年12月12日期间接受肝活检作为晚期HF治疗评估一部分的D期HF患者进行了一项回顾性研究。比较了无纤维化或轻度至中度纤维化（0至2级）组和重度纤维化（3至4级）组的基线特征和1年结局。在519例D期HF患者中，136例接受了肝活检（113例[83%]无纤维化或轻度至中度纤维化，23例[17%]重度纤维化）被纳入研究。共有71例患者（52%）接受了晚期HF治疗（23例心脏移植，48例左心室辅助装置）。重度纤维化患者的1年死亡率更高（52%对18%，p<0.001）。进一步的亚组分析表明，接受晚期治疗的重度纤维化患者1年死亡率有增加趋势（37%对13%，p=0.09）。重度纤维化组接受晚期HF治疗的可能性有降低趋势，仅1例心脏移植和7例左心室辅助装置，但未达到统计学意义（35%对56%，p=0.06）。在对混杂因素进行调整后，肝纤维化程度是死亡率的独立预测因素（比值比6.2；9%可信区间1.27至30.29，p=0.02）。我们得出结论，在接受晚期HF手术治疗评估的D期HF患者中，重度肝纤维化很常见，且显著增加1年死亡率。需要进一步开展更大规模的研究来支持我们的发现。
