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

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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



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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.

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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