ARASHI Hiroyuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Language English
Title Serum Bilirubin/Alanine Aminotransferase Ratio Predict Response to Tolvaptan in Hospitalized Heart Failure Patients
Conference The 79th Annual Scientific Meeting of the Japanese Circulation Society
Promoters Japanese Circulation Society
Conference Type Nationwide Conferences
Presentation Type Speech
Lecture Type General
Publisher and common publisher◎OKAYAMA Dai, MINAMI Yuichiro, SUZUKI Tsuyoshi, SHIGA Tsuyoshi, HARUKI Shintaro, NAKAO Masashi, JUJO Kentaro, ARASHI Hiroyuki, SASHIDA Yukiko, MIZUNO Masayuki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa
Date 2015/04/24
(city and name of the country)
Osaka, JAPAN
Society abstract PROGRAM JCS 2015 181
Summary Background: Liver has high metabolic activity that requires a quarter of cardiac output at rest. Increased central venous pressure leads to passive hepatic congestion so called cholestasis and causes elevation of serum bilirubin (Bil). On the other hand, decreased cardiac output with impaired organ perfusion results in hepatocellular damage and causes elevation of serum alanine aminotransferase (ALT). Tolvaptan, vasopressin type2 receptor antagonist, is used for therapy for heart failure. However it is uncertain that volume overloads and preserved organ perfusion are necessary conditions for response to Tolvaptan, and high Bil/ALT ratio may be a surrogate marker for those conditions. The aim of this study is to investigate the association between Bil/ALT ratio and response to Tolvaptan in hospitalized heart failure(HHF) patients. Methods and Results: We evaluated consecutive 55 HHF patients with Tolvaptan between December 2010 and April 2014.We defined responder to Tolvaptan as 30% increase in urine volume at day2.Receiver operating characteristic (ROC) curve analysis was applied to assess its prognostic value for responder, and Bil/ALT ratio showed favorable performance. The area under the ROC curve was 0.702 (optimal cutoff point >0.057; sensitivity 69.2%; specificity 65.5%). After adjusting for blood pressure and eGFR, high Bil/ALT ratio was an independent predictor for responder (OR:3.66, p=0.02).Conclusions: High Bil/ALT ratio could be a predictive factor for response to Tolvaptan in patients with HHF.