BACKGROUND Liver fibrosis, is independently associated with incident heart failure (HF). Investigating the association between liver fibrosis and type of HF, specifically HF with reduced ejection fraction (EF; HFrEF) or HF with preserved ejection fraction (HFpEF), may provide mechanistic insight into this association. We sought to determine the association between liver fibrosis score (FIB-4) and type of HF, and to assess whether HIV or hepatitis C status modified this association. METHODS We included patients alive on or after 4/1/2003 from the Veterans Aging Cohort Study. We followed patients without prevalent cardiovascular disease until their first HF event, death, last clinic visit, or 9/30/2015. We defined liver fibrosis as: likely advanced fibrosis (FIB-4 > 3.25), indeterminate (FIB-4 range 1.45-3.25), unlikely advanced fibrosis (FIB-4 < 1.45). Primary outcomes were HFrEF and HFpEF (defined using ICD-9 diagnoses for HF, and EF extracted from electronic medical records using natural language processing). Cox proportional hazards models were adjusted for potential confounders and used to estimate hazard ratios (HR). RESULTS Among 108,708 predominantly male (96%) participants mean age was 49 years. Likely advanced fibrosis was present in 4% at baseline and was associated with an increased risk of HFpEF [HR (95% confidence interval)] [1.70 (1.3-2.3)]; and non-significantly with HFrEF [1.20 (0.9-1.7)]. These associations were not modified by HIV or hepatitis C status. CONCLUSION Likely advanced fibrosis was independently associated with incident HFpEF but not HFrEF. This suggests that risk factors and/or mechanisms for liver fibrosis may have greater overlap with those for HFpEF than HFrEF.

中文翻译：

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肝纤维化的 FIB-4 阶段与发生心力衰竭有关，在感染和未感染 HIV 或丙型肝炎的人中射血分数保持但未降低。

背景技术肝纤维化与偶发性心力衰竭（HF）独立相关。研究肝纤维化与心衰类型之间的关联，特别是射血分数降低的心衰（EF；HFrEF）或射血分数保留的心衰（HFpEF），可能会提供对这种关联的机制洞察。我们试图确定肝纤维化评分 (FIB-4) 与 HF 类型之间的关联，并评估 HIV 或丙型肝炎状态是否改变了这种关联。方法 我们从退伍军人老龄化队列研究中纳入了 2003 年 4 月 1 日或之后存活的患者。我们跟踪没有普遍心血管疾病的患者，直到他们第一次心衰事件、死亡、最后一次就诊或 2015 年 9 月 30 日。我们将肝纤维化定义为：可能是晚期纤维化（FIB-4 > 3.25），不确定（FIB-4 范围 1.45-3.25），不太可能的晚期纤维化（FIB-4 < 1.45）。主要结果是 HFrEF 和 HFpEF（使用 ICD-9 对 HF 的诊断定义，以及使用自然语言处理从电子病历中提取的 EF）。Cox 比例风险模型针对潜在的混杂因素进行了调整，并用于估计风险比 (HR)。结果 在 108,708 名主要为男性 (96%) 的参与者中，平均年龄为 49 岁。基线时 4% 可能存在晚期纤维化，并且与 HFpEF 风险增加相关 [HR（95% 置信区间）] [1.70 (1.3-2.3)]；与 HFrEF [1.20 (0.9-1.7)] 无关。这些关联并未因 HIV 或丙型肝炎状态而改变。结论 可能的晚期纤维化与 HFpEF 事件独立相关，但与 HFrEF 无关。