LIVER FUNCTION TESTS AND URIC ACID SERUM LEVELS IN RELATION TO HEMODYNAMIC PROFILE: A COMPARISON BETWEEN HEART FAILURE AND PULMONARY ARTERIAL HYPERTENSION PATIENTS

Background- Systemic venous congestion has been considered the main cause of liver dysfunction in heart failure patients. In this study, we assessed the relation of liver function tests to hemodynamic profile in patients with systolic heart failure (SHF) and primary pulmonary arterial hypertension (PAH).Methods- Fifty patients with left ventricular ejection fraction<35% and 27 patients with mean PAH>25 mmHg were enrolled. Hemodynamic indices, including PAP, right atrial and ventricular pressures (RAP & RVP), pulmonary capillary wedge pressure (PCWP), and cardiac index (CI), were obtained and liver function tests and serum uric acid levels were measured simultaneously. Fifty age- and sex-matched normal controls were also studied.Results- CO was significantly lower in the HF group (P=0.006). Multivariate analysis showed a significant correlation between total bilirubin level and mean PAP (R=0.04, P=0.004), RAP (R=0.33, P<0.03), RVP (R=0.43, P<0.004), PCWP (R=0.36, P<0.01), and direct bilirubin with mean PAP (R=0.01, P=0.02), RVP (R=0.33, P<0.03), PCWP (R=0.32, P<0.03), and CI (R=0.33, P<0.01). In the PAH group, such correlations were mostly absent.Conclusion- Systemic venous congestion, more prominent in PAH, might not play the main role in deteriorating liver function. Further studies are needed to determine whether hepatic blood flow, which is significantly decreased in SHF, is a more important factor.