Published Online
on October 14, 2009

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Original Article

Clinical Predictors of Hepatic Fibrosis in Chronic Advanced Heart Failure

Jill M. Gelow¹; Akshay S. Desai²; Claudia P. Hochberg³; Jonathan N. Glickman²; Michael M. Givertz² and James C. Fang^4,5

¹ Oregon Health and Science University, Portland, Oregon; Brigham and Women's Hospital, Boston, MA;
² Brigham and Women's Hospital, Boston, MA;
³ Brigham and Women's Hospital; Beth Israel Deaconess Medical Center, Boston, MA;
⁴ Brigham and Women's Hospital, Boston, MA; University Hospital-Case Medical Center, Cleveland, OH

^* Corresponding author; email: james.fang{at}uhhospitals.org

Background—The clinical features associated with liver disease in advanced heart failure (HF) patients are poorly defined. We investigated the histopathologic spectrum of liver disease in a contemporary HF population to identify the clinical correlates of hepatic fibrosis.

Methods and Results—We identified 61 patients with advanced HF undergoing evaluation for ventricular assist device (VAD) or cardiac transplantation from 1995-2006, who had liver tissue obtained during the same time period. Electronic medical records were reviewed for clinical data. Biopsy specimens were scored for hepatic fibrosis. Forty-seven patients (79.7%) had hepatic fibrosis on liver biopsy. Of these, 47% had severe fibrosis (Grade 3 or 4). Relative to those without fibrosis, patients with hepatic fibrosis were more likely to have renal dysfunction, moderate or severe tricuspid regurgitation (TR) (odds ratio [OR] 5.0; 95% confidence interval [CI] 1.2, 21.7), and obstructive or mixed liver function (LFTs) abnormalities (OR 5.7; 95% CI 1.4, 22.3). As anticipated, patients with no or mild fibrosis (Grade 1 or 2) on transjugular liver biopsy were more likely to undergo VAD or heart transplant than patients with severe fibrosis (OR 7.8, 95% CI 1.4, 44.0). Accordingly, patients with severe fibrosis were less likely to be alive at the time of data collection (OR 0.07; 95% CI 0.01, 0.42).

Conclusion—Hepatic fibrosis is common in advanced HF patients. Renal dysfunction, significant TR and abnormal LFTs are associated with hepatic fibrosis, but the predictive value of other clinical features is limited. Liver biopsy should be considered in patients undergoing VAD or transplant evaluation.

Key Words: heart-assist device • heart failure • liver • transplantation • Hepatic fibrosis