title: Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography.
abstract: OBJECTIVE
  The impact of cardiac dysfunction on the liver is known as cardiac hepatopathy. In certain instances this can result in significant hepatic fibrosis or cirrhosis. The validity of non-invasive tools to assess hepatic fibrosis, such as FibroScan(®) which measures liver stiffness (LSM), has not been established in this setting. We examined the impact of cardiac dysfunction on LSM using FibroScan(®) and the influence of volume changes on LSM.
  
  
  RESULTS
  A prospective, cross-sectional study examined the use of FibroScan(®) in subjects with left-sided heart failure (LHF, n = 32), right-sided heart failure (RHF, n = 9), and acute decompensated heart failure (ADHF, n = 8). The impact of volume changes upon LSM was further examined in the ADHF group (pre- and post-diuresis) and in a haemodialysis group (HD, n = 12), pre- and post-ultrafiltration on dialysis. Compared with healthy controls [n = 55, LSM = median 4.4 (25th percentile 3.6, 75th percentile 5.1) kPa], LSM was increased in all the cardiac dysfunction subgroups [LHF, 4.7 (4.0, 8.7) kPa, P = 0.04; RHF, 9.7 (5.0, 10.8) kPa, P < 0.001; ADHF, 11.2 (6.7, 14.3) kPa, P < 0.001]. Alteration in volume status via diuresis did not change the baseline LSM in ADHF [11.2 (6.7, 14.3) to 9.5 (7.3, 21.6) kPa, P > 0.05] with mean diuresis 5051 ± 1585 mL, or ultrafiltration in HD [6.0 (3.6, 5.1) vs. 5.7 (4.8, 7.0) kPa, P > 0.05] with mean diuresis 1962 ± 233 mL.
  
  
  CONCLUSIONS
  Our findings support the concept of increased LSM in the cardiac failure population. LSM was not altered to a statistically significant level with acute volume changes.
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, The Alfred Center, Melbourne, Australia. ingrid.hopper@monash.edu
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hopper
authors.forename: William
authors.initials: W
authors.lastname: Kemp
authors.forename: Pornwalee
authors.initials: P
authors.lastname: Porapakkham
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sata
authors.forename: Eilis
authors.initials: E
authors.lastname: Condon
authors.forename: Marina
authors.initials: M
authors.lastname: Skiba
authors.forename: Lauren
authors.initials: L
authors.lastname: Farber
authors.forename: Pramote
authors.initials: P
authors.lastname: Porapakkham
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Williams
authors.forename: Solomon
authors.initials: S
authors.lastname: Menahem
authors.forename: Stuart
authors.initials: S
authors.lastname: Roberts
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004231:Diuresis; D054459:Elasticity Imaging Techniques / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016277:Ventricular Function, Left