Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure.
Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure.
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DOI：
10.1161/jaha.120.016689
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发表时间：
2020-08-04
影响因子：
5.4
通讯作者：
Takeishi Y
中科院分区：
文献类型：
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作者：
Yoshihisa A;Ishibashi S;Matsuda M;Yamadera Y;Ichijo Y;Sato Y;Yokokawa T;Misaka T;Oikawa M;Kobayashi A;Yamaki T;Kunii H;Takeishi Y
有报道称，瞬态弹性图评估的肝硬度与右心房压相关，这与心力衰竭（HF）患者的预后较差有关。我们的目的是澄清肝血流动力学评价的临床意义（肝充血和灌注不足）腹部超声在心衰患者。我们进行了腹部超声检查、右心导管检查和超声心动图检查，然后随访心衰患者的心脏事件，如心源性死亡或心衰恶化。对于肝充血，肝剪切波弹性成像（SWE）评估的肝刚度与右心导管测量的右心房压力（R=0.343； P<0.01）、右心房收缩末期面积和超声心动图测量的下腔静脉直径显著相关。对于肝灌注不足，腹腔动脉的峰值收缩速度（PSV）与右心导管测定的心脏指数（R=0.291； P<0.001）和超声心动图测定的三尖瓣环状平面收缩偏移相关。根据Kaplan-Meier分析，高SWE和低PSV的HF患者心脏事件发生率最高（log‐rank P=0.033）。在Cox比例风险分析中，高SWE和低PSV与高心脏事件发生率相关（高SWE：风险比[HR]， 2.039; 95% CI, 1.131-4.290；低PSV: HR， 2.211; 95% CI, 1.199-4.449），高SWE和低PSV的组合是心脏事件的预测因子（HR, 4.811; 95% CI, 1.562-14.818）。腹部超声检查（肝脏SWE和腹腔PSV）显示的肝内充血和灌注不足与心衰患者的不良预后相关。
It has been reported that liver stiffness assessed by transient elastography are correlated with right atrial pressure, which is associated with worse outcome in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients with HF. We performed abdominal ultrasonography, right‐heart catheterization, and echocardiography, then followed up for cardiac events such as cardiac death or worsening HF in patients with HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography (SWE) of the liver was significantly correlated with right atrial pressure determined by right‐heart catheterization (R=0.343; P<0.01), right atrial end‐systolic area, and inferior vena cava diameter determined by echocardiography. Regarding liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by right‐heart catheterization (R=0.291; P<0.001) and tricuspid annular plane systolic excursion determined by echocardiography. According to the Kaplan–Meier analysis, HF patients with high SWE and low PSV had the highest cardiac event rate (log‐rank P=0.033). In the Cox proportional hazard analysis, high SWE and low PSV were associated with high cardiac event rate (high SWE: hazard ratio [HR], 2.039; 95% CI, 1.131–4.290; low PSV: HR, 2.211; 95% CI, 1.199–4.449), and the combination of high SWE and low PSV was a predictor of cardiac events (HR, 4.811; 95% CI, 1.562–14.818). Intrahepatic congestion and hypoperfusion determined by abdominal ultrasonography (liver SWE and celiac PSV) are associated with adverse prognosis in patients with HF.