Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography
Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography
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DOI：
10.1093/eurjhf/hfs044
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发表时间：
2012-06-01
影响因子：
18.2
通讯作者：
Krum, Henry
中科院分区：
文献类型：
--
作者：
Hopper, Ingrid;Kemp, William;Krum, Henry
心脏功能不全对肝脏的影响被称为心脏性肝病。在某些情况下，这会导致严重的肝纤维化或肝硬变。在这种情况下，非侵入性评估肝纤维化的工具，如测量肝脏硬度(LSM)的FibroScan，其有效性还没有得到证实。我们使用FibroScan检查了心功能不全对LSM的影响，以及容量变化对LSM的影响。一项前瞻性的横断面研究考察了左心衰(LHF，n 32)、右心衰(RHF，n 9)和急性失代偿性心力衰竭(ADHF，n 8)受试者使用FibroScan的情况。在ADHF组(利尿前和利尿后)和血液透析组(HD，n 12)中，进一步研究透析前后容量变化对LSM的影响。与正常对照组比较，左心功能不全亚组左心功能不全组的左心功能不全显著增加[左心功能不全组，左心功能，4.7(4.0，8.7)kPa，P0.04；右心功能不全组，9.7(5.0，10.8)kPaP 0.001；左心功能不全组，11.2(6.7，14.3)kPA，P 0.001]。利尿引起的容量状态改变不会改变ADHF的基线LSM[11.2(6.7，14.3)至9.5(7.3，21.6)kPa，P<0.05]，平均利尿量为5051 1585毫升，或HD组的超滤[6.0(3.6，5.1)对5.7(4.8，7.0)KPA，P<0.05]，平均利尿量1962 233毫升。我们的研究结果支持心力衰竭人群中LSM增加的概念。在急性容量改变时，LSM没有改变到统计学意义上的水平。
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.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.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.