Abstract 13301: Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi YOSHIHISA ◽  
Yasuhiro Ichijo ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Stiffness ◽  
Stable Condition ◽  
Right Atrial ◽  
Clinical Implications ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Hemodynamic Evaluation ◽  
Patients With Heart Failure ◽  
Hepatic Hemodynamic

Background: It has been reported that liver stiffness assessed by transient elastography is correlated with right atrial pressure (RAP), which is an important hemodynamic parameter 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 admitted for the treatment of decompensated HF. Methods and Results: We performed abdominal ultrasonography, right-heart catheterization (RHC), and echocardiography in HF patients (n=342) at stable condition after treatment, then followed up for cardiac events such as cardiac death and re-hospitalization due to worsening HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography of the liver (SWE) was significantly correlated with RAP determined by RHC (R=0.343, P<0.01) and right atrial end systolic area determined by echocardiography (R=0.293, P<0.01). With regard to liver hypoperfusion, peak systolic velocity (PSV) of the celiac artery was correlated with cardiac index determined by RHC (R=0.291, P<0.001) and tricuspid annular plane systolic excursion determined by echocardiography (R=0.251, P=0.004). Importantly, cardiac event rate was highest in HF patients with high SWE and low PSV ( Figure , subset 4). In the Cox proportional hazard analysis, the combination of high SWE and low PSV was a strong predictor of cardiac events (HR 4.811, 95% CI 1.562-14.818). Conclusions: Abdominal ultrasonography based evaluations of intrahepatic congestion and hypoperfusion predict adverse prognosis in HF patients.

Abstract 13304: Liver Dispersion Predicts Adverse Outcomes in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
Yusuke Kimishima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Cardiac Event ◽  
Liver Stiffness ◽  
Adverse Outcomes ◽  
Right Atrial ◽  
Gamma Glutamyl Transferase ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure ◽  
Glutamyl Transferase

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP), and is associated with worse outcome in patients with heart failure (HF). However, the relationship between liver dispersion (LD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and prognostic impacts of LD on HF patients have not been fully examined. We aimed to clarify associations of LD with parameters of liver functional test (LFT) and right-heart catheterization (RHC), and cardiac event such as cardiac death and worsening HF in patients with HF. Methods and Results: We performed abdominal ultrasonography, LFT, RHC, and followed up cardiac events including cardiac death and unplanned hospitalization due to HF in patients with HF (n=157). We examined associations of LD with parameters of LFT and RHC. There were significant correlations between LD and circulating levels of gamma-glutamyl transferase (R=0.197, P=0.018), cholinesterase (R=-0.301, P=0.001), and 7S domain of collagen type IV (P4NP 7S, a marker of fibrosis, R=0.334, P<0.001), but not with RAP (R=0.067, P=0.514) or cardiac index (R=-0.038, P=0.667). During the follow up period (median 305 days), 6 cardiac deaths and 18 unplanned hospitalization due to HF occurred. In the Kaplan-Meier analysis ( Figure ), cardiac event rate was significantly higher in the high LD group (LD ≥10.0 (m/s)/kHz, n=79) than in the low LD group (LD < 10.0 (m/s)/kHz, n=78; log-rank, P=0.007). In the multivariable Cox proportional hazard analysis, high LD was found to be an independent predictor of cardiac event (hazard ratio 3.274, 95% confidence interval 1.203-8.912, P=0.020). Conclusions: LD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

scholarly journals Shear Wave Dispersion Predicts Liver Fibrosis and Adverse Outcomes in Patients with Heart Failure

2020 ◽  
Vol 9 (12) ◽  
pp. 3953
Author(s):  
Himika Ohara ◽  
Akiomi Yoshihisa ◽  
Shinji Ishibashi ◽  
Mitsuko Matsuda ◽  
Yukio Yamadera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Fibrosis ◽  
Shear Wave ◽  
Cardiac Event ◽  
Wave Dispersion ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP) and is associated with worse outcomes in patients with heart failure (HF). However, the relationship between shear wave dispersion (SWD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and the prognostic impact of SWD on HF patients have not been fully examined. We aimed to clarify the associations of SWD with parameters of liver function test (LFT) and right heart catheterization (RHC), as well as with cardiac events such as cardiac death and worsening HF, in patients with HF. Methods: We performed abdominal ultrasonography, LFT and RHC in HF patients (n = 195), and followed up for cardiac events. We examined associations between SWD and parameters of LFT and RHC. Results: There were significant correlations between SWD and circulating levels of direct bilirubin (R = 0.222, p = 0.002), alkaline phosphatase (R = 0.219, p = 0.002), cholinesterase (R = −0.184, p = 0.011), and 7S domain of collagen type IV (R = 0.177, p = 0.014), but not with RAP (R = 0.054, p = 0.567) or cardiac index (R = −0.015, p = 0.872). In the Kaplan–Meier analysis, cardiac event rate was significantly higher in the high SWD group (SWD ≥ 10.0 (m/s)/kHz, n = 103) than in the low SWD group (SWD < 10.0 (m/s)/kHz, n = 92; log-rank, p = 0.010). In the Cox proportional hazard analysis, high SWD was associated with high cardiac event rates (hazard ratio, 2.841; 95% confidence interval, 1.234–6.541, p = 0.014). In addition, there were no interactions between SWD and all subgroups, according to the subgroup analysis. Conclusions: SWD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

scholarly journals Clinical Implications of Hepatic Hemodynamic Evaluation by Abdominal Ultrasonographic Imaging in Patients With Heart Failure

2020 ◽  
Vol 9 (15) ◽  
Author(s):  
Akiomi Yoshihisa ◽  
Shinji Ishibashi ◽  
Mitsuko Matsuda ◽  
Yukio Yamadera ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Implications ◽  
Hemodynamic Evaluation ◽  
Patients With Heart Failure ◽  
Hepatic Hemodynamic

P2605Liver stiffness assessed by fibrosis-4 index; noninvasive marker using serum biomarkers is associated with right ventricular function and cardiovascular prognosis in HFpEF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Nakashima ◽  
S Sakuragi
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Linear Regression Analysis ◽  
Liver Stiffness ◽  
Right Atrial ◽  
Multivariate Linear Regression Analysis ◽  
Cardiac Events ◽  
Kaplan Meier ◽  
Rv Function

Abstract Background Liver stiffness is reported to be associated with right atrial pressure and worse prognosis of heart failure. Fibrosis-4 (FIB4) index (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is known as a useful and simple marker for evaluating liver stiffness. However, the association between FIB4 index and prognosis in heart failure with preserved ejection fraction (HFpEF) was not elucidated. Purpose This study aimed to clarity the association between FIB4 index and right ventricular (RV) function and major adverse cardiac events (MACE) of HFpEF. Method From February 2012 to December 2015, 132 subjects diagnosed as HFpEF after hospitalization of acute decompensation were enrolled (79 years, 59 male). Subjects performed thoracic surgery or percutaneous coronary intervention within half a year and died before discharge were excluded. All subjects were measured FIB4 index and tricuspid annular plane systolic excursion (TAPSE) to assess RV function before discharge. In addition, patients were classified into two groups: high-(≥3.01, n=52) and low-FIB4 index groups (<3.01, n=80). MACE incidence during the follow-up period were compared between these groups. Results Patient with high-FIB4 index were older and higher level of blood pressure. There was no difference in prevalence rates of history of liver disease. In multivariate Linear regression analysis, FIB4 index was significantly association with TAPSE independently confounding factors. Kaplan-Meier analysis showed that patients with high-FIB4 index experienced more CV events during the 1734 days of follow-up (42.3% vs 26.2%, p=0.028) (figure). Kaplan-Meier curve freedom from MACE Conclusions FIB4 index is associated with RV dysfunction and a high risk of future CV event of HFpEF.

Abstract 13334: Cardio-ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi YOSHIHISA ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Yasuhiro Ichijo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Multiple Logistic Regression Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Laboratory Data ◽  
Stable Condition ◽  
Cardiac Events ◽  
Patients With Heart Failure

Aims: We aimed to clarify the associations of cardio-ankle vascular index (CAVI) with exercise capacity and prognosis in patients with heart failure (HF). Methods and Results: We recruited clinical data of total of 273 patients hospitalized for treatment of decompensated HF, and underwent both CAVI and cardiopulmonary exercise testing at stable condition in prior to hospital discharge. For the prediction of impaired peak oxygen uptake (VO 2 ) of < 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. According to the multiple logistic regression analysis, high CAVI was independently associated with impaired peak VO 2 (odds ratio 2.055, 95% confidence interval 1.015-3.960, P = 0.045). We divided these patients based on CAVI: the low CAVI group (CAVI < 8.9, n = 178, 65.2%) and the high CAVI group (CAVI ≥ 8.9, n = 95, 34.8%). We compared the patients’ characteristics and cardiac events such as cardiac death and re-hospitalization due to worsening HF between the two groups. The high CAVI group was older (69.0 vs. 58.0 years old, P < 0.001) and showed lower body mass index (22.9 vs. 23.8 kg/m 2 , P = 0.018). With respect to laboratory data, levels of estimated glomerular filtration rate were lower in the high CAVI group than in the low CAVI group (56.1 vs. 64.2 mL/min/1.73 m 2 , P = 0.001). During the post-discharge follow-up period of median 1,544 days, 76 cardiac events occurred. The Kaplan-Meier analysis showed that cardiac event rates was higher in the high CAVI group than in the low CAVI group ( Figure , Log-rank P = 0.021). In the multivariable Cox proportional hazard analysis, high CAVI was found to be an independent predictor of cardiac events (hazard ratio 1.765, 95% confidence interval 1.123-2.773, P = 0.014). Conclusions: High CAVI independently associated with impaired exercise capacity accompanied by a high cardiac event rate in HF patients.

scholarly journals Liver Stiffness for Predicting Adverse Cardiac Events in Chinese Patients With Heart Failure: A Two-year Prospective Study

2021 ◽  
Author(s):  
Qian Wang ◽  
Yuqing Song ◽  
Qiming Wu ◽  
Qian Dong ◽  
Song Yang
Keyword(s):  
Heart Failure ◽  
Platelet Count ◽  
Natriuretic Peptide ◽  
Liver Stiffness ◽  
Chinese Patients ◽  
Cardiac Events ◽  
Natriuretic Peptide Level ◽  
Adverse Cardiac Events ◽  
Patients With Heart Failure

Abstract Background. To investigate whether liver stiffness (LS) can predict adverse cardiac events in Chinese patients with heart failure (HF). Methods. Total of 53 hospitalized patients with HF were enrolled and LS and tricuspid annual plane systolic excursion (TAPSE)were determined before discharge with Fibroscan® and Echocardiography. The patients were divided into two groups: High LS group(LS >6.9Kpa, n=23) and Low LS group(LS ≤6.9Kp, n=30) . Patients were followed up for 24 months at interval of 3 months. The endpoint of follow-up is death or rehospitalization for HF. Results. All patients were followed up for 24 months or until the endpoint. Patients in High LS group had lower platelet count(P=0.014), lower creatine clear rate (P=0.014), higher level of B-type natriuretic peptide at discharge(P=0.012), and lower tricuspid annual plane systolic excursion (P<0.001). During 24 months follow-up, 3(5.7%) deaths and 21(39.6%) hospitalization were observed. Patients in high LS group had a higher rate of death/rehospitalization when compared with patient in low LS group (Hazard ratio: 4.81; 95% confidence interval:1.69-13.7, P=0.003) after adjustment for age, sex, platelet count, creatine clear rate, and B-type natriuretic peptide level. Also, TAPSE≤16 can predict adverse cardiac events with HR of 6.63 (95% confidence interval:1.69-13.7, P=0.004) for age, sex, platelet count, creatine clear rate, and B-type natriuretic peptide level.Conclusion. LS and TAPSE may be considered for predicting worse outcomes for patients with heart failure.

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan Myers ◽  
Ross Arena ◽  
Daniel Bensimhon ◽  
Joshua Abella ◽  
Leon Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Heart Rate Recovery ◽  
Full Range ◽  
Cardiopulmonary Exercise Testing ◽  
Relative Weight ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

scholarly journals Insomnia and Cardiac Events in Patients With Heart Failure　– Reply –

2017 ◽  
Vol 81 (1) ◽  
pp. 126
Author(s):  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Yasuchika Takeishi
Keyword(s):  
Heart Failure ◽  
Cardiac Events ◽  
Patients With Heart Failure

scholarly journals Liver Stiffness Reflecting Right-Sided Filling Pressure Can Predict Adverse Outcomes in Patients With Heart Failure

2019 ◽  
Vol 12 (6) ◽  
pp. 955-964 ◽  
Author(s):  
Tatsunori Taniguchi ◽  
Tomohito Ohtani ◽  
Hidetaka Kioka ◽  
Yasumasa Tsukamoto ◽  
Toshinari Onishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Stiffness ◽  
Filling Pressure ◽  
Adverse Outcomes ◽  
Patients With Heart Failure
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