Longitudinal trends, hemodynamic profiles, and prognostic value of abnormal liver function tests in patients with acute decompensated heart failure: an analysis of the ESCAPE trial.

BACKGROUND: This study analyzed liver function abnormalities in heart failure patients admitted with severe acute decompensated heart failure (ADHF). METHODS AND RESULTS: A post hoc analysis was conducted with the use of data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE). Liver function tests (LFTs) were measured at 7 time points from baseline, at discharge, and up to 6 months follow-up. Survival analyses were used to assess the association between admission Model of End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) scores and patient outcome.There was a high prevalence of abnormal baseline (admission) LFTs (albumin 23.8%, aspartate transaminase 23.5%, alanine transaminase 23.8%, and total bilirubin 36.1%). The percentage of patients with abnormal LFTs decreased significantly from baseline to 6-months' follow-up. When mean hemodynamic profiles were compared in patients with abnormal versus normal LFTs, elevated total bilirubin was associated with a significantly lower cardiac index (1.80 vs 2.1; P < .001) and higher central venous pressure (14.2 vs 12.0; P = .03). Multivariable analyses revealed that patients with elevated MELD-XI scores (≥16.8) had a 2-fold (hazard ratio 2.06, 95% confidence interval 1.05-4.03) increased risk of death, rehospitalization, or transplantation after adjusting for baseline LFTs, age, sex, race, body mass index, diabetes, and systolic blood pressure. CONCLUSIONS: Abnormal LFTs are common in the ADHF population and are a dynamic marker of an impaired hemodynamic state. Elevated MELD-XI scores are associated with poor outcomes among patients admitted with ADHF.

Myocarditis with normal left ventricular function and troponin of 266.

We are reporting a case, which may represent a new entity within the diagnosis of acute myocarditis. The patient was admitted with new onset atrioventricular block, very high troponin I, peaking at 266ng/mL, and normal left ventricular function. We also used a novel computer tomography technique with delayed enhancement to diagnose myocarditis, as the patient with a permanent pacemaker could not have magnetic resonance imaging.