Background: Chronic Heart Failure is a progressive condition characterised by gradually failure of heart in pumping sufficient blood. There are various established cardiovascular biomarkers (NT-pro BNP & Troponin) and emerging biomarkers (miRNAs, mimecan, orexin). The AST/ALT ratio can be new feasible cardiovascular biomarker as AST is released   from the myocardium and the liver while release of ALT occurs only from the liver. There would be an increase in the AST/ALT ratio in case of injury to the myocardium. Hence the present study was carried out to evaluate the role of the AST/ALT ratio as an indicator of the functional severity in chronic heart failure with reduced left ventricular ejection fraction.

Materials and methods: A one year prospective cross sectional study of 100 subjects of LVEF of ≤ 40% fulfilling the inclusion criteria conducted in KLE Dr.Prabhakar kore Hospital and MRC, Belagavi. Based on the AST/ALT ratio, the study participants were divided into 2 groups - AST/ALT ratio <1 (group 1) and AST/ALT ratio ≥1 (group 2). LVEF, Clinical findings and laboratory parameters were the outcome variables compared by Chi square test. Applicability of AST/ALT ratio to predict the severity of chronic heart failure with reduced EF is checked by Logistic regression and Receiver Operating Characteristic (ROC) curves. 

Results: In present study of 100 subjects, there was a statistically significant difference between two groups with respect to ALT, AST/ALT ratio, and ALP. There was a significant correlation between the APRI index and FIB-4 with AST/ALT ratio. Diagnostic analysis of AST/ALT ratio to predict the severity of chronic heart failure with reduced EF, the area under the curve (AUC) was 0.547 (P-value = 0.5654) with a 95% confidence interval of 0.299 – 0.795 with an optimal cut-off value of 0.6, sensitivity of 96.70%, and specificity of 33.33%.

Conclusion: The AST/ALT ratio is increased in patients with chronic heart failure patients with reduced left ventricular ejection fraction. It is a simple predictor of left ventricular dysfunction in patients with heart failure with reduced ejection fraction.