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Liver stiffness may predict HF severity, outcomes
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Among patients with HF, those with the highest degree of liver stiffness were at elevated risk for mortality and HF rehospitalization, researchers reported.
“These data suggest that [liver stiffness] is a useful index for systemic volume status and predicting the severity of HF, and that the presence of liver congestion at discharge is associated with worse outcomes in HF patients,” Tatsunori Taniguchi, MD, from the department of cardiovascular medicine at Osaka University Graduate School of Medicine in Suita, Japan, and colleagues wrote.
The researchers used transient elastography, a novel noninvasive method, to assess liver stiffness, which can reflect right-sided filling pressure linked to passive liver congestion in those with HF.
The cohort consisted of 171 patients hospitalized with HF who underwent transient elastography before discharge; they were stratified into tertiles based on liver stiffness.
Median liver stiffness was 5.6 kPa (interquartile range [IQR], 4.4-8.1; range, 2.4-39.7) and median right-sided filling pressure was 5.7 mm Hg (IQR, 4.1-8.2; range, 0.1-18.9), according to the researchers.
Those in the highest tertile (liver stiffness > 6.9 kPa, estimated right-sided filling pressure > 7.1 mm Hg) had worse NYHA class, more jugular venous distension and moderate or severe tricuspid regurgitation, larger inferior vena cava diameter, lower levels of hemoglobin and hematocrit, higher levels of serum direct bilirubin and similar left ventricular ejection fraction compared with those in the other two tertiles, Taniguchi and colleagues wrote.
After a median 203 days of follow-up, 5% of patients died and 19% were rehospitalized for HF.
Compared with the other two tertiles, those in the highest tertile of liver stiffness were at elevated risk for death or HF rehospitalization (HR = 3.57; 95% CI, 1.93-6.83), according to the researchers.
Liver stiffness value remained a predictor of worse outcomes even after adjustment for inferior vena cava diameter, serum direct bilirubin and brain natriuretic peptide levels, they wrote.
“This is the first study to demonstrate the prognostic value of [liver stiffness] in patients with HF,” Taniguchi and colleagues wrote. “These results suggest that the assessment of liver congestion at discharge may aid in the management of HF patients.”
In a related editorial, Mathieu Pernot, PhD, from Institut Langevin, Paris, and Olivier Villemain, MD, from Université Paris Descartes, Sorbonne Paris Cité, Paris, wrote that “there remains a long way to go for [liver stiffness] to become a reliable and reproducible tool for the cardiologist.”
However, they wrote, if future studies show that reducing liver stiffness leads to better outcomes in patients with HF, they will produce “new and valuable arguments for implementing therapeutic strategies to reduce hepatic congestion monitored by elastography, which will change our clinical practice.” – by Erik Swain
Disclosures: The authors, Pernot and Villemain report no relevant financial disclosures.
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