title: Liver stiffness is directly influenced by central venous pressure.
abstract: OBJECTIVE
  Liver stiffness (LS) as measured by transient elastography [Fibroscan] offers a novel non-invasive approach to assess liver cirrhosis. Since Fibroscan seems to be unreliable in patients with congestive heart failure, it remains to be determined whether hemodynamic changes affect LS irrespective of fibrosis.
  
  
  RESULTS
  Using landrace pigs, we studied the direct relationship between the central venous pressure and LS measured by Fibroscan. Clamping of the inferior caval vein increased LS from 3.1 to 27.8kPa while reopening reversed LS within 5min to almost normal values of 5.1kPa. We then studied LS as a function of venous pressure in the isolated pig liver by clamping the upper and lower caval, portal vein and hepatic artery. The stepwise increase of intravenous pressure to 36cm of water column (3.5kPa) linearly and reversibly increased LS to the upper detection limit of 75kPa. We finally measured LS in 10 patients with decompensated congestive heart failure before and after recompensation. Initial LS was elevated in all patients, in 8 of them to a degree that suggested liver cirrhosis (median 40.7kPa). Upon recompensation with a median weight loss of 3.0kg, LS decreased in all 10 patients down to a median LS of 17.8kPa. Inflammation could not account for increased LS since initial liver enzyme counts were only slightly elevated and did not change significantly.
  
  
  CONCLUSIONS
  LS is a direct function of central venous pressure which should be considered when assessing the degree of fibrosis.
authors.affiliation: Department of Medicine and Center for Alcohol Research, Liver Disease and Nutrition, Salem Medical Center, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gunda
authors.initials: G
authors.lastname: Millonig
authors.forename: Stefanie
authors.initials: S
authors.lastname: Friedrich
authors.forename: Stefanie
authors.initials: S
authors.lastname: Adolf
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Fonouni
authors.forename: Mohammad
authors.initials: M
authors.lastname: Golriz
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Peter
authors.initials: P
authors.lastname: Stiefel
authors.forename: Gudrun
authors.initials: G
authors.lastname: Pöschl
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Helmut Karl
authors.initials: HK
authors.lastname: Seitz
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002496:Central Venous Pressure / Q000502:physiology*; D004548:Elasticity / Q000502:physiology*; D054459:Elasticity Imaging Techniques; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000502:physiology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D034421:Sus scrofa