Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure

Abstract

Background It has been reported that liver stiffness assessed by transient elastography are correlated with right atrial pressure, which is associated with worse outcome in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients with HF. Methods and Results We performed abdominal ultrasonography, right‐heart catheterization, and echocardiography, then followed up for cardiac events such as cardiac death or worsening HF in patients with HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography (SWE) of the liver was significantly correlated with right atrial pressure determined by right‐heart catheterization ( R =0.343; P <0.01), right atrial end‐systolic area, and inferior vena cava diameter determined by echocardiography. Regarding liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by right‐heart catheterization ( R =0.291; P <0.001) and tricuspid annular plane systolic excursion determined by echocardiography. According to the Kaplan–Meier analysis, HF patients with high SWE and low PSV had the highest cardiac event rate (log‐rank P =0.033). In the Cox proportional hazard analysis, high SWE and low PSV were associated with high cardiac event rate (high SWE: hazard ratio [HR], 2.039; 95% CI, 1.131–4.290; low PSV: HR, 2.211; 95% CI, 1.199–4.449), and the combination of high SWE and low PSV was a predictor of cardiac events (HR, 4.811; 95% CI, 1.562–14.818). Conclusions Intrahepatic congestion and hypoperfusion determined by abdominal ultrasonography (liver SWE and celiac PSV) are associated with adverse prognosis in patients with HF.

Clinical outcomes in patients with heart failure with and without cirrhosis: an analysis from the national inpatient sample

“…This is the first clear evidence that cardiac dysfunction may play a collateral pathogenic role in HRS, with the use of the term "hepatocardiorenal syndrome" in the literature gaining recent traction [4]. Similarly, congestive hepatopathy in the setting of decompensated HF from elevated right atrial pressures adds the risk of further decompensation of liver function, with secondary effects on worsening kidney function [16][17][18]. Thus, the interplay of "hepato-cardiac" disease in those with HF and underlying cirrhosis is potentially a major driver for poor kidney outcomes as well as higher mortality and LOS with its attendant health care resource utilization, as shown in this analysis.…”

Simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) Definition Predicts Bleeding Events in Patients With Heart Failure

“…As HF progresses, organ hypoperfusion and congestion worsen. [53][54][55] Low cardiac output and increased central venous pressure in patients with HF alter gastrointestinal function and cause gastrointestinal bleeding. 27,56 Moreover, once gastrointestinal bleeding occurs, it is associated with higher mortality in both patients with CAD and those with HF.…”

Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

“…RHC was performed with the patients in a stable condition, in a resting supine position under fluoroscopic guidance, at room temperature, and at rest using a 7F Swan-Ganz catheter (Edwards Lifesciences, Irvine, CA). 11,19 Cardiac output was calculated based on the thermodilution method.…”

“…In addition, regarding liver image testing in HF patients, it has been reported that novel liver elastography determined by abdominal ultrasonography is an indicator of liver congestion due to increased right-sided filling pressure (ie, central venous pressure [CVP]). [15][16][17][18][19] However, measurement of liver elastography requires specific abdominal ultrasonographic equipment and is not easy for cardiologists. However, hepatic vein (HV) waveforms have been reported to be useful in the diagnosis of liver fibrosis in patients with chronic liver disease.…”