ASSOCIATION OF AST – ALT RATIO WITH FUNCTIONAL SEVERITY IN HEART FAILURE WITH REDUCED EJECTION FRACTION: A CROSS-SECTIONAL OBSERVATIONAL STUDY
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Keywords
Heart failure; Reduced ejection fraction; AST/ALT ratio; Liver function tests; Functional severity
Abstract
Heart failure with reduced ejection fraction (HFrEF) frequently results in hepatic dysfunction due to persistent venous congestion and a diminished cardiac output. The aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio has been proposed as a marker of disease severity in heart failure. However, its relationship with functional severity is unclear.
Objectives: To evaluate the association between the AST/ALT ratio and functional severity, assessed by the New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF), in patients with HFrEF.
Methods: In this hospital-based cross-sectional study, 75 consecutive patients with HFrEF (LVEF <40%) were enrolled over a year. Patients with primary liver disease, alcohol use, sepsis, malignancy, or hepatotoxic drug exposure were excluded from the study. AST and ALT levels were measured using standardized assays, and the AST-to-ALT ratio was calculated. The participants were stratified into two groups: AST/ALT <1 and AST/ALT ≥1. Functional severity was assessed using the NYHA classification and echocardiographic LVEF. Group comparisons and correlation analyses were conducted.Results: Patients with AST/ALT ≥1 were older and had a higher prevalence of ischemic heart disease. They exhibited higher AST levels, whereas ALT levels were comparable between the groups. Although patients with AST/ALT ≥1 tended to have a higher NYHA class and lower LVEF, the differences were not statistically significant. Correlation analysis demonstrated no significant association between the AST/ALT ratio and the NYHA class or LVEF. The AST/ALT ratio correlated positively with AST levels, suggesting that the ratio elevation was driven primarily by AST increases.
Conclusions: In patients with HFrEF, the AST/ALT ratio was not independently correlated with functional severity, as measured by the NYHA class or LVEF. This ratio appears to reflect hepatic enzyme alterations rather than cardiac functional impairment. These findings support the role of the AST/ALT ratio as an adjunctive marker of hepatic involvement in HFrEF but not as a surrogate of functional severity.
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Dr. Vinoth Khanna Gunasekaran
Associate Professor, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India.
Dr.K.Sunthari
Assistant Professor, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr. K.Ram Kumar
Assitant Professor. Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr. Nichal KM
Post Graduate, Department of General Medicine, Government Thiruvarur Medical College, Thiruvarur, India
Dr. J. B. Ashraf Ali
Associate Professor, Department of Physiology, Government Thiruvarur Medical College, Thiruvarur, India. E-mail: [email protected] Phone: +91 98416 40600
