Soloveva A E, Kobalava Z D, Villevalde S V, Bayarsaikhan M, Garmash I V, Fudim M
Federal State Autonomous Educational Institution of Higher Education, "Peoples' Friendship University of Russia".
Duke University and Duke Clinical Research Institute.
Kardiologiia. 2018(S10):20-32.
There is growing evidence that liver stiffness (LS) in decompensated heart failure (DHF) is related to congestion, however data about its impact on outcomes are limited. The aim of the study was to evaluate associations and long-term prognostic significance of LS measured by transient elastography (TE) in DHF.
Single-center prospective observational study of 194 patients hospitalized with DHF, of whom 71 % were male, 68 ± 11 years (mean ± SD), had a left ventricular ejection fraction of 39±14%. LS by TE (FibroScan 502, Echosens, France) was measured on admission (n=176) and/or discharge (n=165). Outcomes of interest were all-cause death or heart transplantation, heart failure (HF) rehospitalisation, heart valve repair surgery. Outcome analysis was performed with Kaplan-Meier survival curves compared by log-rank test and with Cox proportional hazards regression.
Median LS on admission and discharge were 11.1 (interquartile range 6.3;22.9) and 8.2 (5.8;14.0) kPa, respectively. Higher LS was associated with more clinical congestion on admission and discharge. Patients with LS on admission ≥11.1 kPa and at discharge ≥8.2 kPa were characterised by more pronounced clinical and echocardiographic signs of right-sided HF. Total of 5 (2.6%) patients died in hospital. Further, 31 (17.3%) deaths, 1 (0.6%) heart transplantation, 3 (1.7%) valve repair surgeries and 54 (30.2%) HF rehospitalizations occurred during follow-up (median 183 days). LS ≥ median was associated with higher probability of HF rehospitalizations and composite end point (all-cause death, heart transplantation, HF rehospitalisation and valve replacement therapy) both on admission (logrank p=0.004 and p=0.006) and at discharge (log-rank p=0.001 and p=0.004). Multivariable Cox regression analysis revealed that on a continuous scale LS increase per 1 kPa on admission was related to higher risk of HF hospitalization (hazard ratio [HR] 1.024, 95% confidential interval [CI] 1.002-1.046, p=0.03). LS at discharge was independently associated with increased all-cause mortality (HR per 1 kPa increase 1.098, 95% CI 1.025-1.176, p=0.008), higher risk of HF hospitalization (HR 1.075, 95% CI 1.035-1.117, p.
越来越多的证据表明，失代偿性心力衰竭（DHF）患者的肝脏硬度（LS）与充血有关，然而，关于其对预后影响的数据有限。本研究的目的是评估经瞬时弹性成像（TE）测量的LS在DHF中的相关性及长期预后意义。
对194例因DHF住院的患者进行单中心前瞻性观察研究，其中71%为男性，年龄68±11岁（均值±标准差），左心室射血分数为39±14%。入院时（n=176）和/或出院时（n=165）采用TE（FibroScan 502，法国Echosens公司）测量LS。感兴趣的结局包括全因死亡或心脏移植、心力衰竭（HF）再次住院、心脏瓣膜修复手术。采用Kaplan-Meier生存曲线进行结局分析，并通过对数秩检验和Cox比例风险回归进行比较。
入院时和出院时LS的中位数分别为11.1（四分位间距6.3；22.9）kPa和8.2（5.8；14.0）kPa。较高的LS与入院和出院时更严重的临床充血相关。入院时LS≥11.1 kPa且出院时≥8.2 kPa的患者具有更明显的右侧HF临床和超声心动图体征。共有5例（2.6%）患者在医院死亡。此外，随访期间（中位数183天）发生了31例（17.3%）死亡病例、1例（0.6%）心脏移植、3例（1.7%）瓣膜修复手术和54例（30.2%）HF再次住院。LS≥中位数与入院时（对数秩p=0.004和p=0.006）和出院时（对数秩p=0.001和p=0.004）HF再次住院和复合终点（全因死亡、心脏移植、HF再次住院和瓣膜置换治疗）的较高概率相关。多变量Cox回归分析显示，入院时LS每增加1 kPa，HF住院风险就会增加（风险比[HR] 1.024，95%置信区间[CI] 1.002-1.046，p=0.03）。出院时的LS与全因死亡率增加独立相关（每增加1 kPa的HR为1.098，95% CI 1.025-1.176，p=0.008），HF住院风险更高（HR 1.075，95% CI 1.035-1.117，p.
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