Prognostic effect of liver fibrosis marker in systolic heart failure with cardiac nerve denervation and renal dysfunction.

BACKGROUND: This study aimed to determine the prognostic impact of liver fibrosis on cardiac sympathetic innervation and renal function in patients with heart failure (HF) compared with the well-established prognostic value of cardiorenal and hepatorenal linkage. METHODS: In 525 consecutive patients with HF with left ventricular ejection fraction <50%, the fibrosis-5 index (Fib-5) was calculated to evaluate hepatic dysfunction and liver fibrosis. After 123I-metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes, with lethal cardiac events (CEs) as the primary endpoint, were evaluated for a mean interval of 36.1 ± 26.8 months. CEs were defined as sudden cardiac death, death from heart failure, detection of fatal ventricular arrhythmia, and appropriate implantable cardioverter defibrillator therapy for fatal ventricular arrhythmia. RESULTS: During follow-up, CEs were documented in 139 patients with HF. Fib-5, estimated glomerular filtration rate (eGFR), and the standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in CEs group compared with those in the non-CEs group. The overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. Combining the cut-off values of Fib-5 (<-13.6), eGFR (<41.0 mL/min/1.73 m2), and late sHMR (<1.83), determined by receiver operating characteristic curve analysis further successfully differentiated patients with HF at higher risk for CEs from other patients with HF. CONCLUSIONS: Liver fibrosis parameters are also independent prognostic factors along with cardiac sympathetic nervous function and renal dysfunction in patients with HF, potentially enabling additive risk stratification of these patients.