Abstract 14311: Liver Stiffness Measurement Using Transient Elastography Provides a Noninvasive and Reliable Method to Assess Right-Sided Filling Pressure
Background: Accurate noninvasive assessment of right atrial pressure (RAP) is crucial for volume management in patients with heart failure. Transient elastography is a noninvasive and reliable method to assess liver stiffness (LSTE), which is likely influenced by RAP. We investigated the value of LSTE for evaluation of RAP in patients with cardiopulmonary disease without structural liver disease.
Methods: We prospectively measured LSTE using transient elastography (Fibroscan®) in 31 consecutive patients undergoing right heart catheterization including RAP measurement (test group). The relationship between LSTE and RAP found in the test group was used to derive the best-fit model to predict RAP. The applicability of the model was then tested in a validation group of 49 additional patients. Furthermore, the accuracy of LSTE and echocardiographic parameters for predicting elevated RAP (>10 mmHg) were compared using receiver-operating curve (ROC) analysis.
Results: There was an excellent correlation between LSTE and RAP in the test group (r=0.95, P<0.0001) (Figure A). Natural-log transformation (ln) of LSTE provided the regression equation to predict RAP (RAP = -5.8 + 6.7 х ln [LSTE]), which was found to correlate well with actual RAP in the validation group (r = 0.90, p < 0.0001) (Figure B). The ROC curve analyses in the test group showed that LSTE favorably compared to echocardiography for detecting RAP >10 mmHg (area under the curve 0.958 vs. 0.800, respectively, p = 0.047) (Figure C). In the validation group, LSTE with a cutoff value of 10.6 kPa for identifying RAP >10 mmHg had a higher sensitivity and accuracy (p = 0.046 and p = 0.049, respectively) than echocardiography.
Conclusion: LSTE offers an accurate noninvasive diagnostic method to assess RAP in patients with cardiopulmonary disease.
- © 2013 by American Heart Association, Inc.