Liver Tests and Outcomes in Heart Failure with Reduced Ejection Fraction: Findings from DAPA-HF.

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Liver Tests and Outcomes in Heart Failure with Reduced Ejection Fraction : Findings from DAPA-HF.

Adamson, Carly (author)

Cowan, Lorna M. (author)

de Boer, Rudolf A. (author)

Diez, Mirta (author)

Drozdz, Jaroslaw (author)

Dukat, Andre (author)

Inzucchi, Silvio E. (author)

Kober, Lars (author)

Kosiborod, Mikhail N. (author)

Ljungman, Charlotta, 1977 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine

Martinez, Felipe A. (author)

Ponikowski, Piotr (author)

Sabatine, Marc S. (author)

Lindholm, Daniel (author)

Bengtsson, Olof (author)

Boulton, David W. (author)

Greasley, Peter J. (author)

Langkilde, Anna Maria (author)

Sjostrand, Mikaela (author)

Solomon, Scott D. (author)

McMurray, John J. V. (author)

Jhund, Pardeep S. (author)

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(creator_code:org_t)

2022-08-22
2022
English.
In: European journal of heart failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 24:10, s. 1856-1868

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; https://gup.ub.gu.se...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

AIMS: Reflecting both increased venous pressure and reduced cardiac output, abnormal liver tests are common in patients with severe heart failure and are associated with adverse clinical outcomes. We aimed to investigate the prognostic significance of abnormal liver tests in ambulatory patients with heart failure with reduced ejection fraction (HFrEF), explore any treatment interaction between bilirubin and sodium- glucose cotransporter 2 (SGLT2) inhibitors and examine change in liver tests with SGLT2 inhibitor treatment. METHODS AND RESULTS: We explored these objectives in the Dapagliflozin And Prevention of Adverse outcomes in Heart Failure (DAPA-HF) trial, with focus on bilirubin. We calculated the incidence of cardiovascular death or worsening heart failure by bilirubin tertile. Secondary cardiovascular outcomes were examined, along with the change in liver tests at the end-of-study visit. Baseline bilirubin was available in 4720 patients (99.5%). Participants in the highest bilirubin tertile (T3) have more severe HFrEF (lower left ventricular ejection fraction, higher N-terminal pro-B-type natriuretic peptide [NT-proBNP] and worse New York Heart Association class), had a greater burden of atrial fibrillation but less diabetes. Higher bilirubin (T3 vs. T1) was associated with worse outcomes even after adjustment for other predictive variables, including NT-proBNP and troponin T (adjusted hazard ratio for the primary outcome 1.73 [95% confidence interval 1.37-2.17], p $<$ 0.001; and 1.52 [1.12-2.07], p = 0.01 for cardiovascular death). Baseline bilirubin did not modify the benefits of dapagliflozin. During follow-up, dapagliflozin had no effect on liver tests. CONCLUSION: Bilirubin concentration was an independent predictor of worse outcomes but did not modify the benefits of dapagliflozin in HFrEF. Dapagliflozin was not associated with change in liver tests. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03036124.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

*Heart Failure
Alkaline phosphatase
Bilirubin
Dapagliflozin
Heart failure
Hepatic function
Humans
Liver
SGLT2 inhibitor
Stroke Volume
Ventricular Function
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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

Articles in the publication: European journal ...

By the university: Uppsala University; University of Gothenburg

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