γ-Glutamyl Transferase as a Practical Predictor of Elevated Liver Stiffness in Heart Failure ― Findings From a Daily Clinical Setting ―

BACKGROUND: Liver stiffness assessed by liver elastography has been reported as useful for predicting hepatic congestion and outcomes in patients with heart failure (HF). However, liver elastography is not widely available for patients with HF in routine clinical settings. We investigated whether simple biomarkers can predict elevation of liver stiffness. METHODS AND RESULTS: In all, 52 hospitalized patients with HF were recruited to this study. The primary analysis examined the association between γ-glutamyl transferase (GGT) and liver stiffness in the overall study population. In multivariable linear regression analysis adjusted for age and sex, log-transformed GGT was independently associated with liver stiffness. This association remained significant in separate sensitivity analyses incorporating systolic and diastolic blood pressure, estimated glomerular filtration rate, N-terminal pro B-type natriuretic peptide, ejection fraction, tricuspid regurgitation pressure gradient, inferior vena cava diameter, inferior vena cava collapsibility index, and sodium-glucose cotransporter 2 inhibitor use. In exploratory analyses for the prediction of high liver stiffness (>7.1 kPa), the addition of GGT increased integrated discrimination improvement and improved the net reclassification index, whereas the change in the area under the curve was not statistically significant. Direct comparison between models including GGT and the Fibrosis-4 index did not show a significant difference. CONCLUSIONS: GGT levels may provide a simple and clinically accessible signal associated with elevated liver stiffness in patients with HF and possible hepatic congestion.