Heart failure & cardiomyopathies
Changes in Liver Function Tests, Congestion, and Prognosis After Acute Heart Failure: The STRONG-HF Trial
Main finding · All-cause death or HF hospitalization, by baseline ALTResult — go to the resultHazard ratio 0.82 per log-unit 95% CI 0.66–1.01Authors' conclusion
Lower ALT was associated with lower body mass index and more congestion in AHF, supporting previous studies suggesting ALT as a sarcopenia marker. The beneficial effect of HIC on health status was greater in low baseline ALT patients. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP testinG, of Heart Failure Therapies [STRONG-HF]; NCT03412201).
Study context
- Population
- Acute heart failure (AHF) patients, liver function tests measured 1 to 2 days predischarge and after 90 days of high-intensity care (HIC) or usual care (UC)
- Participants
- 1,062 AHF patients
- Comparison
- High-intensity care vs usual care
- Outcome
- all-cause death or HF hospitalization, by baseline ALT
- Follow-up
- 180-day
Methodological detailsSTRONG-HF protocol
- STRONG-HF protocol
Main finding
As reported in the abstract
Hazard ratio
0.82 per log-unit
95% CI 0.66–1.01
P = 0.06
Per log-unit, as printed
Further findings
Baseline ALT, AST, and total bilirubin (tBil) · 1 to 2 days predischarge
- ALT, median (Q1-Q3)
- 21 (15-32) U/L
- AST, median (Q1-Q3)
- 23 (17-32) U/L
- tBil, median (Q1-Q3)
- 14(10-21) umol/L
Baseline ALT and body mass index and congestion
- Patients with lower ALT had lower body mass index
- Patients with lower ALT, but not tBil or AST, were more likely to have edema, elevated jugular venous pressure, and orthopnea, and use more diuretics prerandomization
Change in ALT, AST, and tBil and congestion · 90 days
- Greater reductions of ALT, AST, and tBil associated with greater improvement of edema, rales, NYHA functional class, and N-terminal pro-B-type natriuretic peptide
Change in AST, tBil and ALT, HIC vs UC · 90 days
- HIC group had a greater reduction in AST and tBil than the UC group, while nonsignificant for ALT
Health status improvement from HIC by baseline ALT
- Patients with lower ALT experienced greater health status improvement from HIC
Original publication
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