Abstract
Liver stiffness (LS) has been reported to be a marker of liver congestion caused by elevated central venous pressure in heart failure (HF) patients. Recent studies demonstrated that LS could be non-invasively measured by virtual touch quantification (VTQ). However, its prognostic implication in patients with acute decompensated heart failure (ADHF) is unclear. This study sought to determine whether LS measured by VTQ could be a determinant of subsequent adverse events in ADHF patients. We prospectively recruited 70 ADHF patients who underwent LS measurement by VTQ on admission in our university hospital between June 2016 and April 2018. The primary outcome of interest was the composite of all-cause mortality and worsening HF. During a median follow-up period of 272 (interquartile range 122–578) days, there were 26 (37%) events, including 5 (7%) deaths and 21 (30%) cases of worsening HF. The c-index of LS for predicting the composite of adverse events was 0.77 (95% CI 0.66–0.88), and the optimal cut-off value of LS was 1.50 m/s. Adverse events were more frequently observed in patients with high LS (≥ 1.50 m/s) compared to those with low LS (< 1.50 m/s). Multivariable Cox regression analyzes revealed that higher LS was independently associated with increased subsequent risk of adverse events after adjustment for confounders. In conclusion, high admission LS was an independent determinant of worse clinical outcomes in patients with ADHF. This finding suggests that LS on admission is useful for risk stratification of patients with ADHF.
Similar content being viewed by others
References
Braunwald E (2013) Heart failure. JACC Heart Fail 1:1–20
Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL (2009) Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 53:582–588
Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WH (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596
Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707
Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM (1994) Complications and failures of subclavian-vein catheterization. N Engl J Med 331:1735–1738
Hopper I, Kemp W, Porapakkham P, Sata Y, Condon E, Skiba M, Farber L, Porapakkham P, Williams TJ, Menahem S, Roberts S, Krum H (2012) Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography. Eur J Heart Fail 14:621–627
Potthoff A, Schettler A, Attia D, Schlue J, Schmitto JD, Fegbeutel C, Struber M, Haverich A, Manns MP, Wedemeyer H, Gebel M, Schneider A (2015) Liver stiffness measurements and short-term survival after left ventricular assist device implantation: a pilot study. J Heart Lung Transplant 34:1586–1594
Taniguchi T, Sakata Y, Ohtani T, Mizote I, Takeda Y, Asano Y, Masuda M, Minamiguchi H, Kanzaki M, Ichibori Y, Nishi H, Toda K, Sawa Y, Komuro I (2014) Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am J Cardiol 113:552–558
Yoshitani T, Asakawa N, Sakakibara M, Noguchi K, Tokuda Y, Kamiya K, Iwano H, Yamada S, Kudou Y, Nishida M, Shimizu C, Amano T, Tsutsui H (2016) Value of virtual touch quantification elastography for assessing liver congestion in patients with heart failure. Circ J 80:1187–1195
Taniguchi T, Ohtani T, Kioka H, Tsukamoto Y, Onishi T, Nakamoto K, Katsimichas T, Sengoku K, Chimura M, Hashimoto H, Yamaguchi O, Sawa Y, Sakata Y (2018) Liver stiffness reflecting right-sided filling pressure can predict adverse outcomes in patients with heart failure. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2017.10.022
McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446
Schiller NB, Acquatella H, Ports TA, Drew D, Goerke J, Ringertz H, Silverman NH, Brundage B, Botvinick EH, Boswell R, Carlsson E, Parmley WW (1979) Left ventricular volume from paired biplane two-dimensional echocardiography. Circulation 60:547–555
Massie BM, O'Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, Weatherley BD, Cleland JG, Givertz MM, Voors A, DeLucca P, Mansoor GA, Salerno CM, Bloomfield DM, Dittrich HC, Committees PIa (2010) Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med 363(15):1419–1428
Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Ponikowski P, Unemori E, Voors AA, Adams KF Jr, Dorobantu MI, Grinfeld LR, Jondeau G, Marmor A, Masip J, Pang PS, Werdan K, Teichman SL, Trapani A, Bush CA, Saini R, Schumacher C, Severin TM, Metra M, RiAHFR-A Investigators (2013) Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 381(9860):29–39
Dzau VJ, Colucci WS, Hollenberg NK, Williams GH (1981) Relation of the renin–angiotensin-aldosterone system to clinical state in congestive heart failure. Circulation 63:645–651
Stewart JM, Zeballos GA, Woolf PK, Dweck HS, Gewitz MH (1988) Variable arginine vasopressin levels in neonatal congestive heart failure. J Am Coll Cardiol 11:645–650
Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, Hillege HL (2007) Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail 9:872–878
Uthoff H, Thalhammer C, Potocki M, Reichlin T, Noveanu M, Aschwanden M, Staub D, Arenja N, Socrates T, Twerenbold R, Mutschmann-Sanchez S, Heinisch C, Jaeger KA, Mebazaa A, Mueller C (2010) Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure. Eur J Heart Fail 12:469–476
Adamson PB, Magalski A, Braunschweig F, Bohm M, Reynolds D, Steinhaus D, Luby A, Linde C, Ryden L, Cremers B, Takle T, Bennett T (2003) Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol 41:565–571
Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL (2014) Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 35:455–469
Maeder MT, Rickli H, Pfisterer ME, Muzzarelli S, Ammann P, Fehr T, Hack D, Weilenmann D, Dieterle T, Kiencke S, Estlinbaum W, Brunner-La Rocca HP (2012) Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy. Am Heart J 163(407–414):414.e1
Murata A, Kasai T, Matsue Y, Matsumoto H, Yatsu S, Kato T, Suda S, Hiki M, Takagi A, Daida H (2018) Relationship between blood urea nitrogen-to-creatinine ratio at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Vessels 33:877–885
Takaya Y, Yoshihara F, Yokoyama H, Kanzaki H, Kitakaze M, Goto Y, Anzai T, Yasuda S, Ogawa H, Kawano Y, Kangawa K (2017) Impact of decreased serum albumin levels on acute kidney injury in patients with acute decompensated heart failure: a potential association of atrial natriuretic peptide. Heart Vessels 32:932–943
Jalal Z, Iriart X, De Ledinghen V, Barnetche T, Hiriart JB, Vergniol J, Foucher J, Thambo JB (2015) Liver stiffness measurements for evaluation of central venous pressure in congenital heart diseases. Heart 101:1499–1504
Kashiyama N, Toda K, Nakamura T, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, Saito S, Yoshioka D, Sawa Y (2017) Evaluation of right ventricular function using liver stiffness in patients with left ventricular assist device. Eur J Cardiothorac Surg 51:715–721
Millonig G, Friedrich S, Adolf S, Fonouni H, Golriz M, Mehrabi A, Stiefel P, Poschl G, Buchler MW, Seitz HK, Mueller S (2010) Liver stiffness is directly influenced by central venous pressure. J Hepatol 52:206–210
Nishi H, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Kawamura M, Saito T, Yoshioka D, Daimon T, Sawa Y (2015) Novel method of evaluating liver stiffness using transient elastography to evaluate perioperative status in severe heart failure. Circ J 79:391–397
Colli A, Pozzoni P, Berzuini A, Gerosa A, Canovi C, Molteni EE, Barbarini M, Bonino F, Prati D (2010) Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology 257:872–878
Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, Couzigou P, de Ledinghen V (2010) Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 51:828–835
Lynch M, Higgins E, McCormick PA, Kirby B, Nolan N, Rogers S, Lally A, Vellinga A, Omar H, Collins P (2014) The use of transient elastography and FibroTest for monitoring hepatotoxicity in patients receiving methotrexate for psoriasis. JAMA Dermatol 150:856–862
Rizzo L, Calvaruso V, Cacopardo B, Alessi N, Attanasio M, Petta S, Fatuzzo F, Montineri A, Mazzola A, L'Abbate L, Nunnari G, Bronte F, Di Marco V, Craxi A, Camma C (2011) Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 106:2112–2120
Acknowledgments
The authors are grateful to Kota Ohno, PhD, for statistical support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest to declare.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Omote, K., Nagai, T., Asakawa, N. et al. Impact of admission liver stiffness on long-term clinical outcomes in patients with acute decompensated heart failure. Heart Vessels 34, 984–991 (2019). https://doi.org/10.1007/s00380-018-1318-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-018-1318-y