Abstract 2098: Clinical Predictors of Hepatic Fibrosis in Chronic Heart Failure

Background : Chronic heart failure (HF) may lead to irreversible liver injury and cirrhosis. However, the clinical features associated with advanced liver disease in HF patients are poorly defined. We sought to determine the clinical predictors of hepatic fibrosis in HF patients undergoing evaluation for heart transplant or ventricular assist device (VAD). Methods : Of 873 patients evaluated by the Advanced Heart Disease Service at our hospital from 1995–2006, we identified 61 patients who had liver tissue available for analysis. Pathologic specimens were obtained from the transjugular approach (n=35), at the time of VAD implantation (n=8), or at autopsy (n=18). Electronic medical records were reviewed for medical history and clinical data. Biopsy specimens were reviewed by a dedicated pathologist and scored for hepatic fibrosis. Tissue was insufficient for scoring in 2 patients. Student’s t-test and Chi-Square tests were used to compare clinical characteristics between patients with and without fibrosis. Results : Of the 59 patients with sufficient tissue for analysis, 47 had hepatic fibrosis on liver biopsy. As shown (Table), patients with hepatic fibrosis had worse renal function and were more likely to have moderate or severe tricuspid regurgitation (TR) (OR 5.0; 95% CI 1.2–21.7) and obstructive or mixed liver function (LFT) abnormalities (OR 5.0; 95% CI 1.4–22.4) than patients without hepatic fibrosis. There was no association between hepatic fibrosis and gender, age, type of cardiomyopathy, duration of symptoms, left or right ventricular function, filling pressures, hepatitis C status or abnormal abdominal imaging. Conclusions : Hepatic fibrosis is common in patients with advanced HF. Renal insufficiency, significant TR and abnormal LFTs were associated with hepatic fibrosis, but the predictive value of other clinical features is limited. Liver biopsy may be the best assessment of hepatic fibrosis in HF patients prior to transplantation or VAD.