Prognostic significance of liver enzyme elevations in acute coronary syndromes

Authors: K. Vyskočilová 1;  L. Špinarová 1;  J. Špinar 2;  J. Vítovec 1;  S. Littnerová 3;  T. Mikušová 1;  J. Pařenica 2;  J. Jarkovský 3
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně a Mezinárodní centrum klinického výzkumu, Brno 1;  Interní kardiologická klinika LF MU a FN Brno 2;  Institut bio­statistiky a analýz LF a PřF MU, Brno 3
Published in: Kardiol Rev Int Med 2014, 16(1): 25-30
Category: Cardiology Review


The prognostic significance of the laboratory parameters associated with hepatic impairment has been proven in many studies. However, only a few of them focused on the predictive value of liver enzymes in acute coronary syndromes (ACS). The aim of our study was to evaluate the prognostic significance of abnormal liver function tests in patients hospitalised with ACS and concomitant acute heart failure.

Methods and results:
Of 8,818 patients included in the AHEAD (Acute Heart Failure Database) registry, 359 patients had ACS on admission and complete records on aspartate aminotransferase (AST), alanine aminotransferase (ALT), g‑ glutamyltransferase (GGT), and alkaline phosphatase (ALP) serum levels. The incidence of abnormalities was as follows –  AST in 71.3%, ALT in 55.2%, ALP in 11.7% and GGT in 31.8%. A significant association with short‑term (30- day) mortality was found in AST and ALT. A significant influence of AST, ALP and GGT was found in the case of long‑term mortality.

Despite the development of modern myocardial ischaemia bio­markers, the role of liver function tests due to their high accessibility and affordability remains irreplaceable. As indicated by our study, the predictive value of liver enzymes is also highly important.

liver function tests –  acute heart failure –  myocardial infarction –  prognosis


1. Spinar J, Parenica J, Vitovec J et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care 2011; 15: R291. doi: 10.1186/ cc10584.

2. Nikolaou M, Parissis J, Yilmaz MB et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 2013; 34: 742– 749. doi: 10.1093/ eurheartj/ ehs332.

3. Allen LA, Felker GM, Pocock S et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail 2009; 11: 170– 177. doi: 10.1093/ eurjhf/ hfn031.

4. Ambrosy AP, Vaduganathan M, Huffman MD et al. Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 2012; 14: 302– 311. doi: 10.1093/ eurjhf/ hfs007.

5. Poelzl G, Ess M, Mussner‑ Seeber C et al. Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur J Clin Invest 2012; 42: 153– 163. doi: 10.1111/ j.1365– 2362.2011.02573.x.

6. Spinarova L, Spinar J, Vitovec J et al. Gender dif­ferences in total cholesterol levels in patiens with acute heart failure and its importance for short and long time prognosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156: 21– 28. doi: 10.5507/ bp.2012.015.

7. Felšöci M, Pařenica J, Špinar J et al. Does previous hypertension affect outcome in acute heart failure? Eur J Intern Med 2011; 22: 591– 596. doi: 10.1016/ j.ejim.2011.09.006.

8. Miklík R, Felšöci M, Pařenica et al. Prevalence anémie a vliv na hospitalizační mortalitu pacientů přijatých pro akutní srdeční selhání. Vnitr Lek 2010; 56: 382– 391.

9. Tomcikova D, Felsoci M, Spinar J et al. Risk of in‑hospital mortality identified according to the typology of patients with acute heart failure: classification tree analysis on data from the Acute Heart Failure Database‑ Main registry. J Crit Care 2013; 28: 250– 258. doi: 10.1016/ j.jcrc.2012.09.014.

10. Pařenica J, Špinar J, Vítovec J et al. Long‑term survival following acute heart failure: The Acute Heart Failure Database Main registry (AHEAD Main). Eur J Intern Med 2013; 24: 151– 160. doi: 10.1016/ j.ejim.2012.11.005.

11. Helánová K, Špinar J, Jarkovský J et al. Kardiorenální syndrom u pacientů s akutním srdečním sel­háním. Kardiol Rev 2012; 14: 240– 245.

12. Ladue JS, Wroblewski F, Karmen A. Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction. Science 1954; 120: 497– 499.

13. Ladenson JH. Reflections on the evolution of cardiac bio­markers. Clin Chem 2012; 58: 21– 24. doi: 10.1373/ clinchem.2011.165852.

14. Kim D, Kim WR, Kim HJ et al. Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology 2013; 57: 1357– 1365. doi: 10.1002/ hep.26156.

15. Schindhelm RK, Dekker JM, Nijpels G et al. Alanine aminotransferase predicts coronary heart disease events: a 10‑year follow‑up of the Hoorn study. Atherosclerosis 2007; 191: 391– 396.

16. Lazzeri C, Valente S, Tarquini R et al. Prognostic values of admission transaminases in ST‑elevation myocardial infarction submitted to primary angioplasty. Med Sci Monit 2010; 16: CR567– CR574.

17. Lofthus DM, Stevens SR, Armstrong PW et al. Pattern of liver enzyme elevations in acute ST‑elevation myocardial infarction. Coron Artery Dis 2012; 23: 22– 30. doi: 10.1097/ MCA.0b013e32834e4ef1.

18. Goessling W, Massaro JM, Vasan RS et al. Aminotransferase levels and 20‑year risk of metabolic syndrome, diabetes and cardiovascular disease. Gastroenterology 2008; 135: 1935– 1944. doi: 10.1053/ j.gastro.2008.09.018.

19. Koehler EM, Sanna D, Hansen BE et al. Serum liver enzymes are associated with all‑cause mortality in an elderly population. Liver Int 2014; 34: 296– 304. doi: 10.1111/ liv.12311.

20. Peterson B, Trell E, Kristensson H et al. Comparison of gamma‑ glutamyltransferase and other health screening tests in average middle‑ aged males, heavy drinkers and alcohol non‑users. Scand J Clin Lab Invest 1983; 43: 141– 149.

21. Pompella A, Emdin M, Passino C et al. The significance of serum gamma‑ glutamyltransferase in cardiovascular diseases. Clin Chem Lab Med 2004; 42: 1085– 1091.

22. Paolicchi A, Minotti G, Tonarelli P et al. Gamma‑ glutamyl transpeptidase‑ dependent iron reduction and LDL oxidation – a potential mechanism in atherosclerosis. J Investig Med 1999; 47: 151– 160.

23. Ruttmann E, Brant LJ, Concin H et al. Gamma‑ glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation 2005; 112: 2130– 2137.

24. Wannamethee G, Ebrahim S, Shaper AG. Gamma‑ glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 1995; 142: 699– 708.

25. Emdin M, Passino C, Michelassi C et al. Prognostic value of serum gamma‑ glutamyl transferase activity after myocardial infarction. Eur Heart J 2001; 22: 1802– 1807.

26. Meisinger C, Döring A, Schneider A et al. KORA Study Group. Serum gamma‑ glutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population. Atherosclerosis 2006; 189: 297– 302.

27. Fein PA, Asadi S, Singh P et al. Relationship between alkaline phosphatase and all‑cause mortality in peritoneal dialysis patients. Adv Perit Dial 2013; 29: 61– 63.

Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account