Prognostic value of liver stiffness in patients with acute decompensated heart failure

Authors: Tereshina O.V., Ketsko Yu.L., Usenko E.V., Efimova E.P., Reshetnikova Yu.B., Popov M.A.

Company: 1 Samara State Medical University, Samara, Russian Federation
2 “Reaviz” Medical University, Samara, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2022-16-2-216-225

For citation: Tereshina O.V., Ketsko Yu.L., Usenko E.V., Efimova E.P., Reshetnikova Yu.B., Popov M.A. Prognostic value of liver stiffness in patients with acute decompensated heart failure. Creative Cardiology. 2022; 16 (2): 216–25 (in Russ.). DOI: 10.24022/1997-3187-2022-16-2-216-225

Received / Accepted:  20.03.2022 / 24.06.2022

Keywords: liver stiffness liver elastography acute heart failure echocardiography right ventricular dysfunction

Download
Full text:  

 

Abstract

Objective. To estimate the prognostic significance of liver stiffness determination in acute decompensated heart failure. Elastography of the liver is widely used in the staging of liver disease. In patients with heart failure, increased liver stiffness is a manifestation of stasis and depends on central venous pressure.

Material and methods. A single-center prospective cohort study included 121 patients hospitalized with acute heart failure at the Samara State Medical University Clinics. Thirty-three of them were excluded because of the presence of other factors that might have influenced the value of liver stiffness. The remaining 88 patients underwent echocardiography and hepatic elastography. Posthospital median follow-up was 6 months. Statistical analysis was performed by calculating nonparametric indices of descriptive statistics, investigating qualitative (logistic regression) and quantitative (correlation analysis) relationships of the studied variables. Classification variables in the calculations were: the fact of repeated hospitalization and lethal outcome.

Results. Adverse cardiac events, ie, death or rehospitalization, occurred in 33 patients (5 and 28 patients, respectively). Stiffness score had a strong correlation with risk of rehospitalization (AUC (area under the curve) 0.85; p < 0.0001) and mortality (AUC 0.91; p < 0.0001). Significant additional echo features determining the risk of hospitalization were right ventricular ejection fraction 3D (AUC 0.93, p < 0.0001), calculated pulmonary artery systolic pressure (AUC 0.90, p < 0.0001), and right ventricular free wall strain (AUC 0.86, p < 0.0001). Echo criteria with close prognostic significance were determined: systolic excursion of the tricuspid valve annulus plane (AUC 0.88, p < 0.0001), systolic pulmonary artery pressure (AUC 0.85, p < 0.0001), 3D right ventricular ejection fraction (AUC 0.84, p < 0.0001).

Conclusion. Determination of liver stiffness by point shear wave elastography can be used as a prognostic marker of adverse events in patients with acute heart failure. Increased liver stiffness in heart failure significantly correlates with echocardiographic indices.

References

  1. Njoroge J.N., Teerlink J.R. Pathophysiology and therapeutic approaches to acute decompensated heart failure. Circ. Res. 2021; 128 (10): 1468–86. DOI: 10.1161/CIRCRESAHA.121.318186
  2. Lee Y.H., Kim K.J., Yoo M.E., Kim G., Yoon H.J., Jo K., Youn J.C. et al. Association of non-alcoholic steatohepatitis with subclinical myocardial dysfunction in non-cirrhotic patients. J. Hepatol. 2018; 68 (4): 764–72. DOI: 10.1016/j.jhep.2017.11.023
  3. Allen L.A., Felker G.M., Pocock S., McMurray J.J., Pfeffer M.A., Swedberg K. et al. CHARM Investigators. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur. J. Heart Fail. 2009; 11 (2): 170–7. DOI: 10.1093/eurjhf/hfn031
  4. Xanthopoulos A., Starling R.C., Kitai T., Triposkiadis F. Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail. 2019; 7 (2): 87–97. DOI: 10.1016/j.jchf.2018.10.007
  5. Samsky M.D., Patel C.B., DeWald T.A., Smith A.D., Felker G.M., Rogers J.G., Hernandez A.F. Cardiohepatic interactions in heart failure: an overview and clinical implications. J. Am. Coll. Cardiol. 2013; 61 (24): 2397–405. DOI: 10.1016/j.jacc.2013.03.042
  6. Møller S., Bernardi M. Interactions of the heart and the liver. Eur. Heart J. 2013; 34 (36): 2804–11. DOI: 10.1093/eurheartj/eht246
  7. Ferraioli G., Barr R.G. Ultrasound liver elastography beyond liver fibrosis assessment. World J. Gastroenterol. 2020; 26 (24): 3413–20. DOI: 10.3748/wjg.v26.i24.3413
  8. Taniguchi T., Sakata Y., Ohtani T., Mizote I., Takeda Y., Asano Y. et al. Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am. J. Cardiol. 2014; 113 (3): 552–8. DOI: 10.1016/j.amjcard.2013.10.018
  9. Taniguchi T., Ohtani T., Kioka H., Tsukamoto Y., Onishi T., Nakamoto K. et al. Liver stiffness reflecting right-sided filling pressure can predict adverse outcomes in patients with heart failure. JACC Cardiovasc. Imaging. 2019; 12 (6): 955–64. DOI: 10.1016/j.jcmg.2017.10.022
  10. Saito Y., Kato M., Nagashima K., Monno K., Aizawa Y., Okumura Y. et al. Prognostic relevance of liver stiffness assessed by transient elastography in patients with acute decompensated heart failure. Circ. J. 2018; 82 (7): 1822–9. DOI: 10.1253/circj. CJ-17-1344
  11. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M. et al. ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021; 42 (36): 3599–726. DOI: 10.1093/eurheartj/ehab368
  12. Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015; 28 (1): 1–39.e14. DOI: 10.1016/j.echo.2014.10.003
  13. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F., 3rd, Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging. 2016; 17 (12): 1321–60. DOI: 10.1093/ehjci/jew082 Barr R.G., Wilson S.R., Rubens D., Garcia-Tsao G., Ferraioli G. Update to the Society of Radiologists in ultrasound liver elastography consensus statement. Radiology. 2020; 296 (2): 263–74. DOI: 10.1148/radiol.2020192437
  14. Colli A., Pozzoni P., Berzuini A., Gerosa A., Canovi C., Molteni E.E. et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010; 257 (3): 872–8. DOI: 10.1148/radiol.10100013.
  15. Sciaccaluga C., Mandoli G.E., Nannelli C., Falciani F., Rizzo C., Sisti N. et al. Survival in acute heart failure in intensive cardiac care unit: a prospective study. Int. J. Cardiovasc. Imaging. 2021; 37 (4): 1245–53. DOI: 10.1007/s10554-020-02109-8
  16. Khan M.S., Siddiqi T.J., Khan S.U., Shah S.J., VanWagner L.B., Khan S.S. Association of liver stiffness and cardiovascular outcomes in patients with heart failure: a systematic review and metaanalysis. Eur. J. Prev. Cardiol. 2020; 27 (3): 331–4. DOI: 10.1177/2047487318810013
  17. Solov’eva A.E., Kobalava Z.D., Villevalde S.V., Bayarsaikhan M., Garmash I.V., Fudim M. Prognostic value of liver stiffness in decompensated heart failure: results of prospective observational transient elastography-based study. Kardiologiia. 2018; 58 (10S): 20–32 (in Russ.) DOI: 10.18087/cardio.2488
  18. Arzilli C., Aimo A., Vergaro G., Ripoli A., Senni M., Emdin M., Passino C. N-terminal fraction of proB-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure. Eur. J. Prev. Cardiol. 2018; 25 (8): 889–95. DOI: 10.1177/2047487318766580

About Authors

  • Ol’ga V. Tereshina, Associate Professor, Head of Department; ORCID
  • Yuriy L. Ketsko, Cand. Med. Sci., Associate Professor; ORCID
  • Ekaterina V. Usenko, Assistant Professor, Functional Diagnostician; ORCID
  • Ekaterina P. Efimova, Assistant Professor, Functional Diagnostician; ORCID
  • Yuliya B. Reshetnikova, Assistant Professor, Functional Diagnostician; ORCID
  • Mikhail A. Popov, PhD student; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery