Diagnostic and Prognostic Role of Liver Elastography in Heart Failure

Abstract Background: Hepatic congestion is a frequent finding in patients with heart failure (HF). Physical examination has limitations in quantifying systemic congestion and requires correlation with echocardiographic and laboratory data (usually B-type natriuretic peptide, BNP, or N-terminal pro-B type natriuretic peptide, NT-proBNP). Hepatic elastography evaluates liver stiffness using a transducer that transmits low-frequency vibrations (50 Hz), and the speed of shear waves propagating through the tissues is measured by ultrasound. The faster the vibrations propagate in the hepatic parenchyma, the stiffer the liver, which, in case of HF, can be correlated with hepatic congestion. Objective: In this systematic review, case-controls, cohort studies, and randomized clinical trials were searched in MEDLINE, LILACS and Cochrane Database of Systematic Review, to evaluate the use of elastography in the detection of hepatic congestion in patients with HF. Methods: From the 49 articles retrieved, seven were selected for review, according to the inclusion and exclusion criteria. The most used methods for the diagnosis and evaluation of HF were echocardiography combined with BNP and NT-proBNP measurements. Results: Elastography performed at bedside was able to establish a significant correlation between increased liver stiffness and increased venous capillary pressure. In addition, liver elastography performed at hospital discharge was able to predict rehospitalization and mortality. Conclusion: Liver elastography is a non-invasive method that can be useful in predicting prognosis and mortality of individuals with HF, contributing to the clinical management of these patients.

背景：肝淤血（hepatic congestion）是心力衰竭（heart failure, HF）患者的常见临床表现。体格检查在量化体循环淤血方面存在局限性，需结合超声心动图及实验室检测数据（通常为B型钠尿肽（B-type natriuretic peptide, BNP）或N末端B型钠尿肽前体（N-terminal pro-B type natriuretic peptide, NT-proBNP））进行综合研判。肝脏弹性成像（hepatic elastography）借助发射低频振动（50Hz）的换能器评估肝脏硬度，通过超声检测剪切波在组织中的传播速度：振动在肝实质内的传播速度越快，肝脏硬度越高，而在心力衰竭患者中，该指标可与肝淤血程度形成相关性关联。

目的：本系统综述检索了MEDLINE、LILACS及Cochrane系统评价数据库中收录的病例对照研究、队列研究及随机临床试验，以评估弹性成像在心力衰竭患者肝淤血检测中的应用价值。

方法：初检共获取49篇文献，依据纳入与排除标准筛选后，最终纳入7篇文献进行综述。当前用于心力衰竭诊断与评估的最常用方案为超声心动图联合BNP及NT-proBNP检测。

结果：床旁弹性成像可明确证实肝硬度升高与静脉毛细血管压升高之间存在显著相关性。此外，出院时实施的肝脏弹性成像能够预测患者的再住院风险与死亡风险。

结论：肝脏弹性成像是一种无创检查方法，可用于预测心力衰竭患者的预后及死亡风险，可为此类患者的临床管理提供有效支持。