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Heart failure and cardiomyopathies
Original research article
Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure
  1. Yu Sato,
  2. Akiomi Yoshihisa,
  3. Yuki Kanno,
  4. Shunsuke Watanabe,
  5. Tetsuro Yokokawa,
  6. Satoshi Abe,
  7. Tomofumi Misaka,
  8. Takamasa Sato,
  9. Satoshi Suzuki,
  10. Masayoshi Oikawa,
  11. Atsushi Kobayashi,
  12. Takayoshi Yamaki,
  13. Hiroyuki Kunii,
  14. Kazuhiko Nakazato,
  15. Shu-ichi Saitoh and
  16. Yasuchika Takeishi
  1. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
  1. Correspondence to Dr Akiomi Yoshihisa; yoshihis{at}fmu.ac.jp

Abstract

Objective Liver dysfunction due to heart failure (HF) is known as congestive hepatopathy. It has recently been reported that liver stiffness assessed by transient elastography reflects increased central venous pressure. The Fibrosis-4 (FIB4) index (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is expected to be useful for evaluating liver stiffness in patients with non-alcoholic fatty liver disease. We aimed to investigate the impact of the FIB4 index on HF prognosis, with consideration for liver fibrosis markers and underlying cardiac function.

Methods Consecutive 1058 patients with HF who were admitted to our hospital were divided into three groups based on their FIB4 index: first (FIB4 index <1.72, n=353), second (1.72≤FIB4 index <3.01, n=353) and third tertiles (3.01≤FIB4 index, n=352). We prospectively followed for all-cause mortality.

Results During the follow-up period (mean 1047 days), 246 deaths occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from the first to third groups (12.2%, 21.0% and 36.6%, p<0.01). In the Cox proportional hazard analysis, FIB4 index was an independent predictor of all-cause mortality in patients with HF (p<0.05). In comparisons of laboratory and echocardiographic findings, the third tertile had higher levels of type IV collagen 7S, procollagen type III peptide, hyaluronic acid, left atrial volume, mitral valve E/e’, inferior vena cava diameter and right atrial end systolic area (p<0.01, respectively).

Conclusion The FIB4 index, a marker of liver stiffness, is associated with higher all-cause mortality in patients with HF.

  • heart failure

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000598

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    Footnotes

    • Contributors AY and YT: drafted thearticle and conceptualised the study; YS and YK: performed the statisticalanalysis; SW, TY, SA, TM, TS, SS, MO, AK, TY, HK and KN: obtained general data;SS and YT: revised the article critically for important intellectual content.

    • Competing interests None declared.

    • Patient consent Obtained

    • Ethics approval Ethical Committee of Fukushima Medical University.

    • Provenance and peer review Not commissioned; internally peer reviewed.