Abstract 13635: Liver Stiffness Measured by Transient Elastography is a Strong Predictor of Clinical Events in Patients With Heart Failure
Background: Passive liver congestion due to elevated right-sided filling pressure is a common finding in patients with heart failure (HF). However, the clinical impact of liver congestion on HF outcomes has been poorly described. Transient elastography (TE) is a new non-invasive method to evaluate liver stiffness (LSTE). We investigated the impact of LSTE on clinical outcomes in HF patients without structural liver disease.
Methods: LSTE values in 107 consecutive HF patients (age 66±15 years, male 66%, LVEF 43±20%) were determined before discharge using a Fibroscan® device. Patients with severe obesity, substantial ascites, and chronic liver disease were excluded. Patients were followed for cardiac death or rehospitalization due to HF. ROC curve analysis was used to derive optimal cutoff value for predicting outcomes. Cox proportional-hazards regression was used to adjust for the effect of differences in pertinent covariates on the clinical event rate.
Results: During follow-up, 23 patients (21%) died or were hospitalized for decompensated HF after a median follow-up of 81 days (5-433 days). ROC curve analysis of LSTE for predicting events revealed an optimal cutoff value of 10.1kPa. The cardiac event rate was higher in patients with LSTE≧10.1 kPa than in those with LSTE <10.1kPa (46% vs 11%, p<0.0001). Kaplan-Meier analysis illustrated that patients with elevated LSTE (≧10.1kPa) had a significantly higher risk of cardiac events (log-rank test p<0.0001). After adjusting for age, sex, total bilirubin, LVEF, and NT-proBNP, high LSTE (≧10.1kPa) was still associated with a higher event rate (HR:5.32, 95% CI:2.07-14.84, p=0.0005).
Conclusions: LSTE offers a rapid and noninvasive diagnostic method to identify patients at a risk of cardiac death or rehospitalization for HF.
- © 2013 by American Heart Association, Inc.