# A Novel Liver Fibrosis Marker FIB‐5 Index Predicted Response to Cardiac Resynchronization Therapy and Prognostic Outcomes in Patients With Heart Failure

## TL;DR

The FIB-5 index, a liver fibrosis marker, predicts response to heart failure treatment and improves prognosis outcomes.

## Contribution

The FIB-5 index is shown to predict cardiac resynchronization therapy response and prognosis in heart failure patients.

## Key findings

- Patients with a higher FIB-5 index were more likely to respond to CRT.
- The FIB-5 index improved risk stratification for hospitalization and death in heart failure patients.
- The FIB-5 index increased significantly in responders after 6 months of CRT.

## Abstract

The fibrosis‐5 (FIB‐5) index is a noninvasive marker for assessing the progression of liver fibrosis and predictor in patients with heart failure (HF). This study investigated the association between the FIB‐5 index and response to cardiac resynchronization therapy (CRT) and evaluated its predictive value for prognosis.

In total, 203 patients who underwent CRT/CRT‐defibrillator (CRT‐D) implantation were retrospectively included. The FIB‐5 index was calculated using blood samples obtained before and after CRT/CRT‐D. Response to CRT was defined as a relative reduction in left ventricular end‐systolic volume of ≥15% 6 months after CRT/CRT‐D. We compared the prognosis after CRT/CRT‐D between the groups according to the FIB‐5 index.

One hundred and twenty‐three patients (61%) responded to CRT. The responder group demonstrated a significantly higher FIB‐5 index than the nonresponder group (−2.76 ± 3.85 vs. −4.67 ± 3.29, p < 0.001). Receiver‐operating characteristic analysis demonstrated that the area under the curve of the FIB‐5 index was 0.660 with a cutoff value of −4.00 for responders. In multivariate analysis, FIB‐5 index ≥ −4.00 was an independent predictor for CRT response (odds ratio: 3.665, p = 0.003), in addition to QRS duration ≥ 150 ms and echocardiographic dysynchrony. The FIB‐5 index increased significantly after 6 months in the responder group but not in the nonresponder group. The FIB‐5 index ≥ −4.00 group showed a significantly better prognosis for cardiac death, HF hospitalization, and composite endpoint than the FIB‐5 index < −4.00 group.

The FIB‐5 index in addition to classical predictors may be a useful marker for predicting response to CRT.

Liver fibrosis and prognoses after CRT are strongly associated. The FIB‐5 index may be a useful marker for predicting response to CRT, with the potential benefit of risk stratification for the development of hospitalization for HF and all‐cause death.