Key result
Lower Fib-5 index (<-13.6), reduced eGFR (<41.0), and low late sHMR (<1.83) were independent predictors of lethal cardiac events in patients with systolic heart failure.
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Why the study?
The prognostic impact of liver fibrosis on cardiac sympathetic innervation and renal function in patients with heart failure was unclear compared with established cardiorenal and hepatorenal prognostic factors.
Does prognostic assessment of liver fibrosis (Fib-5 index) combined with cardiac sympathetic innervation and renal function improve prediction of lethal cardiac events in patients with heart failure and LVEF <50%?
Cohort (n=525)
Does prognostic assessment of liver fibrosis (Fib-5 index) combined with cardiac sympathetic innervation and renal function improve prediction of lethal cardiac events in patients with heart failure and LVEF <50%?
Liver fibrosis parameters, combined with cardiac sympathetic nerve function and renal dysfunction, provide additive risk stratification for lethal cardiac events in patients with systolic heart failure.
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.
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Hatano et al. (2026) conducted a cohort in Heart failure with left ventricular ejection fraction <50% (n=525). Liver fibrosis marker (Fib-5 index) vs. Patients with higher Fib-5 index (less fibrosis) was evaluated on Lethal cardiac events (sudden cardiac death, death from heart failure, fatal ventricular arrhythmia, and appropriate ICD therapy). Lower Fib-5 index (<-13.6), reduced eGFR (<41.0), and low late sHMR (<1.83) were independent predictors of lethal cardiac events in patients with systolic heart failure.
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