Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis
Abstract Background Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and met...
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BMC
2025-04-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04647-2 |
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| author | Parham Dastjerdi Mehrdad Mahalleh Hedieh Shayesteh Mohammad Sadeq Najafi Roozbeh Narimani-Javid Mohadese Dashtkoohi Seyed Ali Mofidi Kaveh Hosseini Masih Tajdini |
| author_facet | Parham Dastjerdi Mehrdad Mahalleh Hedieh Shayesteh Mohammad Sadeq Najafi Roozbeh Narimani-Javid Mohadese Dashtkoohi Seyed Ali Mofidi Kaveh Hosseini Masih Tajdini |
| author_sort | Parham Dastjerdi |
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| description | Abstract Background Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic value of liver function markers (albumin, bilirubin, AST, ALT, ALP) in HFpEF patients. Methods A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies assessing the association of liver markers with adverse outcomes in HFpEF. The primary outcome was a composite of heart failure-related hospitalization or death. Hazard ratios (HR) were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Results Twenty studies involving 30,623 patients were included. Serum albumin, the main marker of our study, was significantly associated with a reduced risk of adverse outcomes in a meta-analysis of 16 studies (HR 0.71, 95% CI: 0.61–0.83; I² = 87%). After excluding outliers, heterogeneity decreased (I² = 23%), and the association remained significant (HR 0.75, 95% CI: 0.69–0.82). Although no significant associations were found for AST, ALT, ALP, or bilirubin with adverse outcomes, the limited number of studies for these markers may have contributed to the lack of statistical significance. Conclusion Higher serum albumin levels predict better outcomes in HFpEF, while other liver function markers showed limited prognostic utility. Serum albumin may serve as a valuable marker for risk stratification in HFpEF. Graphical Abstract |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-e1024758af0844f78cca76638fb864b42025-08-20T01:53:19ZengBMCBMC Cardiovascular Disorders1471-22612025-04-0125111610.1186/s12872-025-04647-2Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysisParham Dastjerdi0Mehrdad Mahalleh1Hedieh Shayesteh2Mohammad Sadeq Najafi3Roozbeh Narimani-Javid4Mohadese Dashtkoohi5Seyed Ali Mofidi6Kaveh Hosseini7Masih Tajdini8Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesResearch Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesVali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical SciencesStudent Research Committee, School of Medicine, Shahid Beheshti University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesAbstract Background Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic value of liver function markers (albumin, bilirubin, AST, ALT, ALP) in HFpEF patients. Methods A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies assessing the association of liver markers with adverse outcomes in HFpEF. The primary outcome was a composite of heart failure-related hospitalization or death. Hazard ratios (HR) were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Results Twenty studies involving 30,623 patients were included. Serum albumin, the main marker of our study, was significantly associated with a reduced risk of adverse outcomes in a meta-analysis of 16 studies (HR 0.71, 95% CI: 0.61–0.83; I² = 87%). After excluding outliers, heterogeneity decreased (I² = 23%), and the association remained significant (HR 0.75, 95% CI: 0.69–0.82). Although no significant associations were found for AST, ALT, ALP, or bilirubin with adverse outcomes, the limited number of studies for these markers may have contributed to the lack of statistical significance. Conclusion Higher serum albumin levels predict better outcomes in HFpEF, while other liver function markers showed limited prognostic utility. Serum albumin may serve as a valuable marker for risk stratification in HFpEF. Graphical Abstracthttps://doi.org/10.1186/s12872-025-04647-2Heart failurePreserved ejection fractionLiver function biomarkersSerum albuminMeta-analysis |
| spellingShingle | Parham Dastjerdi Mehrdad Mahalleh Hedieh Shayesteh Mohammad Sadeq Najafi Roozbeh Narimani-Javid Mohadese Dashtkoohi Seyed Ali Mofidi Kaveh Hosseini Masih Tajdini Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis BMC Cardiovascular Disorders Heart failure Preserved ejection fraction Liver function biomarkers Serum albumin Meta-analysis |
| title | Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis |
| title_full | Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis |
| title_fullStr | Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis |
| title_full_unstemmed | Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis |
| title_short | Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis |
| title_sort | liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction a systematic review and meta analysis |
| topic | Heart failure Preserved ejection fraction Liver function biomarkers Serum albumin Meta-analysis |
| url | https://doi.org/10.1186/s12872-025-04647-2 |
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