Elevated Transpulmonary Gradient Is a Predictor of Survival in Patients with WHO Group II Pulmonary Hypertension Treated with Continuous-Flow Left Ventricular Assist Devices (CF-LVAD)

poorly understood. Methods: Data from ASCEND-HF, a randomized clinical trial of patients with acute heart failure (AHF) regardless of left ventricular ejection fraction (LVEF), was used to characterize LFTs at baseline. Logistic regression assessed the association of LFTs and 30-day all-cause mortality and HF rehospitalization; Cox proportional hazards models were used for 180-day all-cause mortality among patients alive at a day 30 landmark. Regression was performed using continuous variables (transformed for linearity assumptions when appropriate) and a dichotomous variable (normal vs. abnormal) for each liver function test. Separate analyses were performed for individual LFT. Abnormal bilirubin was defined as O1.0 mg/dL; for AST and ALT, abnormal values were defined as O35 U/L. Results: Among 4,228 ASCEND-HF patients with LFT data, 42% had abnormal total bilirubin, 22% had abnormal ALT, and 30% had abnormal AST on admission. Patients with abnormal LFTs were younger, had lower body mass index, and lower LVEF compared to those with admission LFTs within the normal range. In multivariable models, higher levels of total bilirubin levels were associated with increased 30-day mortality or HF rehospitalization (HR 1.17 per unit change, 95% CI 1.04, 1.32), and a non-significant trend for 180-day mortality (HR 1.10, 95% CI 0.97, 1.25) (Table 1). Compared with normal baseline LFTs, the presence of an abnormal bilirubin was independently associated with increased 30-day all-cause mortality or HF rehospitalization (HR 1.24, 95% CI 1.00, 1.54) and 180-day mortality (HR 1.32, 95% CI 1.08, 1.62). After adjustment, there was no association between AST or ALT and either outcome. Conclusions: In this trial of patients with AHF, abnormalities in LFTs were common on presentation. Elevated total bilirubin, but no other liver function test, was independently associated with worse outcomes at 30and 180-days.