急性心力衰竭后肝功能检查、充血及预后的变化：STRONG-HF试验
Changes in Liver Function Tests, Congestion, and Prognosis After Acute Heart Failure: The STRONG-HF Trial.
作者信息
Myhre Peder L, Grupper Avishay, Mebazaa Alexandre, Davison Beth, Edwards Christopher, Takagi Koji, Adamo Marianna, Arrigo Mattia, Barros Marianela, Biegus Jan, Celutkiene Jelena, Čerlinskaitė-Bajorė Kamilė, Chioncel Ovidiu, Cohen-Solal Alain, Damasceno Albertino, Deniau Benjamin, Diaz Rafael, Filippatos Gerasimos, Gayat Etienne, Kimmoun Antoine, Ter Maaten Jozine M, Metra Marco, Novosadova Maria, Pagnesi Matteo, Pang Peter S, Ponikowski Piotr, Saidu Hadiza, Sliwa Karen, Tomasoni Daniela, Voors Adriaan, Cotter Gad, Lam Carolyn S P
机构信息
K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway.
Division of Cardiology, Shamir Medical Center Beer Yakov, Be'er Ya'akov, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
出版信息
JACC Adv. 2025 Mar;4(3):101607. doi: 10.1016/j.jacadv.2025.101607. Epub 2025 Feb 21.
BACKGROUND
Elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (tBil) may reflect congestion and liver dysfunction in acute heart failure (AHF), while lower ALT also associates with sarcopenia.
OBJECTIVES
The purpose of this study was to assess ALT, AST, and tBil levels in AHF patients during high-intensity care (HIC) vs usual care (UC) follow-up.
METHODS
ALT, AST, and tBil were measured 1 to 2 days predischarge in 1,062 AHF patients, and again after 90 days of either HIC or UC according to the STRONG-HF (Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP testinG, of Heart Failure therapies) protocol. The primary endpoint was 180-day all-cause death or HF hospitalization.
RESULTS
Median (Q1-Q3) baseline ALT, AST, and tBil were 21 (15-32) U/L, 23 (17-32) U/L, and 14(10-21) umol/L, respectively. Patients with lower ALT had lower body mass index. Patients with lower ALT, but not tBil or AST, were more likely to have edema, elevated jugular venous pressure, and orthopnea, and use more diuretics prerandomization. A nonsignificant inverse association between ALT and the primary outcome (HR: 0.82 [95% CI: 0.66-1.01] per log-unit, P = 0.06) was observed. Greater reductions of ALT, AST, and tBil to 90 days were associated with greater improvement of edema, rales, NYHA functional class, and N-terminal pro-B-type natriuretic peptide. After 90 days, the HIC group had a greater reduction in AST and tBil than the UC group, while nonsignificant for ALT. The treatment effect of HIC over UC on the primary outcome was consistent across the baseline ALT, AST, and tBil range (all P interaction >0.10), but patients with lower ALT experienced greater health status improvement from HIC.
CONCLUSIONS
Lower ALT was associated with lower body mass index and more congestion in AHF, supporting previous studies suggesting ALT as a sarcopenia marker. The beneficial effect of HIC on health status was greater in low baseline ALT patients. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP testinG, of Heart Failure Therapies [STRONG-HF]; NCT03412201).
背景
丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（tBil）升高可能反映急性心力衰竭（AHF）中的充血和肝功能障碍，而较低的ALT也与肌肉减少症相关。
目的
本研究旨在评估AHF患者在高强度护理（HIC）与常规护理（UC）随访期间的ALT、AST和tBil水平。
方法
对1062例AHF患者在出院前1至2天测量ALT、AST和tBil，并根据STRONG-HF（心力衰竭治疗的快速优化的安全性、耐受性和疗效，由NT-proBNP检测辅助）方案在HIC或UC治疗90天后再次测量。主要终点是180天全因死亡或心力衰竭住院。
结果
基线ALT、AST和tBil的中位数（Q1-Q3）分别为21（15-32）U/L、23（17-32）U/L和14（10-21）μmol/L。ALT较低的患者体重指数较低。ALT较低但tBil或AST不低的患者更有可能出现水肿、颈静脉压升高和端坐呼吸，并且在随机分组前使用更多利尿剂。观察到ALT与主要结局之间存在非显著的负相关（每对数单位的风险比：0.82 [95%置信区间：0.66-1.01]，P = 0.06）。到90天时ALT、AST和tBil的更大降幅与水肿、啰音、纽约心脏协会（NYHA）功能分级和N末端B型利钠肽前体的更大改善相关。90天后，HIC组的AST和tBil降幅大于UC组，而ALT降幅无统计学意义。HIC相对于UC对主要结局的治疗效果在基线ALT、AST和tBil范围内是一致的（所有P交互作用>0.10），但ALT较低的患者从HIC中获得的健康状况改善更大。
结论
较低的ALT与AHF患者较低的体重指数和更多的充血相关，支持先前将ALT作为肌肉减少症标志物的研究。HIC对低基线ALT患者的健康状况有益效果更大。（心力衰竭治疗的快速优化的安全性、耐受性和疗效，由NT-proBNP检测辅助[STRONG-HF]；NCT03412201）
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