Liver stiffness in cardiac insufficiency: Is elevated GGT due to cardiac cirrhosis?

Introduction: Cardiac insufficiency may severely impair hepatic function either due to congestion or impaired perfusion and eventually leads to cardiac cirrhosis. We recently showed that central venous pressure directly affects liver stiffness (LS) independent of fibrosis stage. In the present study, cardiac and hepatic determinants of increased LS are studied in patients with acute cardiac decompensation.

Methods and patients: 100 retrospectively analysed patients (learning cohort) and 14 prospective patients (validation cohort) with acute heart failure, liver tests, echocardiography and LS were sequentially measured at the days of admission and release.

Results: In the learning cohort, 50 patients (50%) had an elevated GGT. LS exceeded 8 kPa in 14 of 21 patients (66.6%), which is considered as the cut-off value for advanced fibrosis (F3). In confirmation, 9 of 14 patients (64.2%) from the prospective validation cohort exceeded 8 kPa. LS decreased significantly during cardiac recompensation in 8 of these 9 patients from a mean of 22.2 kPa to 16.4 kPa (mean observation interval of 6.3 days). The decrease of LS correlated significantly with the weight loss. In 6 patients (42.8%), LS remained above 8 kPa despite a sufficient diuretic therapy. Ultrasound morphology further established cardiac cirrhosis in 5 of these patients. In this cirrhotic group, increased LS was excellently associated with bilirubin, NYHA state and GGT. GGT was 3.3 higher in the fibrotic subpopulation which was the highest ratio among all parameters apart from LS.

Conclusion: LS is significantly increased in two thirds of patients with cardiac decompensation while sequential LS measurements suggest manifest F3/4 cardiac fibrosis in ca. 50%. Since GGT as established prognostic marker for heart failure is especially increased in the fibrotic subpopulation, cardiac liver fibrosis itself could be underestimated progression factor in heart insufficiency e.g. via further water retention.

Literatur: Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease Hepatic Medicine: Evidence and Research 2010;2:49-67.

GGT - cardiac cirrhosis - cardiac insufficiency - liver stiffness