ReviewProgress in cardiovascular diseases
FIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C.
Review in Progress in cardiovascular diseases. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Prognostic value of FIB-4 and NFS for cardiovascular events in patients with and without NAFLD.BMC public health · 2025Pooled it
- Association between noninvasive hepatic fibrosis indices and heart failure mortality.Medicine · 2026Observational
- Organ cross-talk: molecular mechanisms, biological functions, and therapeutic interventions for diseases.Signal transduction and targeted therapy · 2026Review
- Systemic Interactions in HFpEF: A Multiorgan Perspective on Pathways and Therapeutic Targets.Journal of cardiovascular translational research · 2025Review
- Combination of the Fibrosis 4 Index and Carbohydrate Antigen 125 to Predict Morbidity and Mortality in Acute Heart Failure.Reviews in cardiovascular medicine · 2025Article
- Multi-model applications and cutting-edge advancements of artificial intelligence in hepatology in the era of precision medicine.World journal of gastroenterology · 2025Review
- Fibrosis-4 index is closely associated with future development of hypertension in the Japanese general population.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- TyG index and MAFLD severity are associated with subclinical LV dysfunction in T2DM patients: a cross-sectional study.Frontiers in endocrinology · 2025Article
- Triglyceride-glucose index and FIB-4 score in relation to cardiovascular disease risk among people with HIV: a retrospective cohort study.Frontiers in medicine · 2025Article
- Association of liver fibrosis scores with all-cause and cardiovascular mortality in patients with heart failure.Clinical and translational science · 2024Article
- Association Between Noninvasive Liver Fibrosis Scores and Heart Failure in a General Population.Journal of the American Heart Association · 2024Article
- A Population-Based and Clinical Cohort Validation of the Novel Consensus Definition of Metabolic Hyperferritinemia.The Journal of clinical endocrinology and metabolism · 2024Article
- Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing.PloS one · 2024Article
- Fibrosis-4 index is closely associated with clinical outcomes in acute cardioembolic stroke patients with nonvalvular atrial fibrillation.Internal and emergency medicine · 2023Article
- Prognostic implication of liver fibrosis scores in patients with non-ischemic dilated cardiomyopathy.European heart journal open · 2023Article
- Development and Challenges of Pre-Heart Failure with Preserved Ejection Fraction.Reviews in cardiovascular medicine · 2023Review
- Association Between End-Stage Liver Disease and Incident Heart Failure in an Integrated Health System.Journal of general internal medicine · 2023Article
- Characterizing Heart Failure With Preserved Ejection Fraction in End-Stage Liver Disease and Liver Transplant Outcomes.JACC. Asia · 2023Article
- Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction.ESC heart failure · 2023Article
- Candidate Screening for Heart Failure With Preserved Ejection Fraction Clinic by Fib-4 Index From Subclinical Subjects.Gastro hep advances · 2023Article
Corrections and comments
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Authors and funding
21 authors at 11 institutions in 2 countries.
Funding
Abstract
backgroundLiver 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.
methodsWe 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).
resultsAmong 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.
conclusionLikely 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.