Author + information
- Received February 23, 2017
- Revision received October 3, 2017
- Accepted October 19, 2017
- Published online January 17, 2018.
- Tatsunori Taniguchi, MDa,
- Tomohito Ohtani, MDa,∗ (, )
- Hidetaka Kioka, MDa,
- Yasumasa Tsukamoto, MDa,
- Toshinari Onishi, MDa,
- Kei Nakamoto, MDa,
- Themistoklis Katsimichas, MDa,
- Kaoruko Sengoku, MDa,
- Misato Chimura, MDa,
- Haruko Hashimoto, MSb,
- Osamu Yamaguchi, MDa,
- Yoshiki Sawa, MDc and
- Yasushi Sakata, MDa
- aDepartment of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- bDepartment of Medical Innovation, Osaka University Hospital, Suita, Japan
- cDepartment of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- ↵∗Address correspondence to:
Dr. Tomohito Ohtani, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine 2-2 Yamadaoka, Suita, 565-0871, Japan.
Objectives This study sought to investigate whether elevated liver stiffness (LS) values at discharge reflect residual liver congestion and are associated with worse outcomes in patients with heart failure (HF).
Background Transient elastography is a newly developed, noninvasive method for assessing LS, which can be highly reflective of right-sided filling pressure associated with passive liver congestion in patients with HF.
Methods LS values were determined for 171 hospitalized patients with HF before discharge using a Fibroscan device.
Results The median LS value was 5.6 kPa (interquartile range: 4.4 to 8.1; range 2.4 to 39.7) and that of right-sided filling pressure, which was estimated based on LS, was 5.7 mm Hg (interquartile range: 4.1 to 8.2 mm Hg; range 0.1 to 18.9 mm Hg). The patients in the highest LS tertile (>6.9 kPa, corresponding to an estimated right-sided filling pressure of >7.1 mm Hg) had advanced New York Heart Association functional class, high prevalence of jugular venous distention and moderate/severe tricuspid regurgitation, large inferior vena cava (IVC) diameter, low hemoglobin and hematocrit levels, high serum direct bilirubin level, and a similar left ventricular ejection fraction compared with the lower tertiles. During follow-up periods (median: 203 days), 8 (5%) deaths and 33 (19%) hospitalizations for HF were observed. The patients in the highest LS group had a significantly higher mortality rate and HF rehospitalization (hazard ratio: 3.57; 95% confidence interval: 1.93 to 6.83; p < 0.001) compared with the other tertiles. Although LS correlated with IVC diameter and serum direct bilirubin and brain natriuretic peptide levels, LS values were predictive of worse outcomes, even after adjustment for these indices.
Conclusions These data suggest that LS is a useful index for assessing systemic volume status and predicting the severity of HF, and that the presence of liver congestion at discharge is associated with worse outcomes in patients with HF.
This study was supported in part by a Grant-in-Aid from the Japanese Society for the Promotion of Science (No. 15K09080) and a research grant from Osaka Heart Club. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 23, 2017.
- Revision received October 3, 2017.
- Accepted October 19, 2017.
- 2018 American College of Cardiology Foundation
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