Liver stiffness and prediction of cardiac outcomes in patients with acute decompensated heart failure.
Sumeet K. Asrani M.D.
Panchani, N., Schulz, P., Van Zyl, J., Felius, J., Baxter, R., Yoon, E.T., Baldawi, H., Bindra, A. and Asrani, S.K. (2021). “Liver stiffness and prediction of cardiac outcomes in patients with acute decompensated heart failure.” Clin Transplant Nov 24;e14545. [Epub ahead of print]. e14545.
BACKGROUND: In acute decompensated heart failure (ADHF), noninvasive markers that predict morbidity and mortality are limited. Liver stiffness measurement (LSM) increases with hepatic fibrosis; however, it may be falsely elevated in patients with ADHF in the absence of liver disease. We investigated whether elevated LSM predicts cardiac outcomes in ADHF. METHODS: In a prospective study, we examined 52 ADHF patients without liver disease between 2016 and 2017. Patients underwent liver 2D shear wave elastography (SWE) and were followed for 12 months to assess the outcomes of left ventricular assist device (LVAD), heart transplant (HT) or death. RESULTS: The median LSM was elevated in patients who received an LVAD or HT within 30-days compared to those who did not (median [IQR]: 55.6 [22.5 – 63.4] vs 13.8 [9.5 – 40.3] kPa, p = .049). Moreover, the risk of composite outcome was highest in the 3rd tertile (> 39.8 kPa compared to 1(st) and 2(nd) combined, HR 2.83, 95% CI 1.20- 6.67, p = .02). Each 1-kPa increase in LSM was associated with a 1%-increase in the incidence rate of readmissions (IRR 1.01, 95% CI 1.00-1.02, p = .01). CONCLUSIONS: LSM may serve as a novel noninvasive tool to determine LVAD, HT, or death in patients with ADHF.