title: Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure.
abstract: OBJECTIVE
  Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF).
  
  
  METHODS
  The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline.
  
  
  RESULTS
  In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs.
  
  
  CONCLUSIONS
  Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.
authors.affiliation: 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital in Brno, International Clinical Research Center and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Vyskocilova
authors.affiliation: 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital in Brno, International Clinical Research Center and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Spinarova
authors.affiliation: 1st Department of Internal Medicine - Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital in Brno, International Clinical Research Center and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Tereza
authors.initials: T
authors.lastname: Mikusova
authors.affiliation: 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital in Brno, International Clinical Research Center and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Vitovec
authors.affiliation: Internal Department, Hospital Havlickuv Brod, Havlickuv Brod.
authors.forename: Josef
authors.initials: J
authors.lastname: Malek
authors.affiliation: Department of Cardiology, Na Homolce Hospital, Prague.
authors.forename: Filip
authors.initials: F
authors.lastname: Malek
authors.affiliation: 2nd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague.
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
authors.affiliation: 1st Department of Internal Medicine - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc.
authors.forename: Marian
authors.initials: M
authors.lastname: Fedorco
authors.affiliation: Cardiocenter, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University in Prague.
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.affiliation: Department of Internal Medicine, T. Bata Regional Hospital, Zlin.
authors.forename: Cestmir
authors.initials: C
authors.lastname: Cihalik
authors.affiliation: 1st Department of Internal Medicine - Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno.
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Sciences, Masaryk University, Brno.
authors.forename: Simona
authors.initials: S
authors.lastname: Littnerova
authors.affiliation: Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Sciences, Masaryk University, Brno.
authors.forename: Jiri
authors.initials: J
authors.lastname: Jarkovsky
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase
keywords: bilirubin; congestive hepatopathy; heart failure; ischemic hepatitis; liver function tests