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Liver stiffness assessed by magnetic resonance elastography predicts clinical outcomes in patients with heart failure and without chronic liver disease

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Abstract

Objectives

Evaluation of liver stiffness (LS) by magnetic resonance elastography (MRE) is useful for estimating right atrial pressure (RAP) in patients with heart failure (HF). However, its prognostic implications are unclear. We sought to investigate whether LS measured by MRE (LS-MRE) could predict clinical outcomes in patients with HF.

Methods

We prospectively examined 207 consecutive HF patients between April 2018 and May 2021 after excluding those with organic liver disease. All patients underwent 3.0-T MRE. The primary outcome of interest was the composite of all-cause death and hospitalisation for HF.

Results

During a median follow-up period of 720 (interquartile range [IQR] 434–1013) days, the primary outcome occurred in 44 patients (21%), including 15 (7%) all-cause deaths and 29 (14%) hospitalisations for HF. The patients were divided into two groups according to median LS-MRE of 2.54 (IQR 2.34–2.82) kPa. Patients with higher LS-MRE showed a higher incidence of the primary outcome compared to those with lower LS-MRE (p < 0.001). Multivariable Cox regression analyses revealed that LS-MRE value was independently associated with the risk of adverse events (hazard ratio 2.49, 95% confidence interval 1.46–4.24). In multivariable linear regression, RAP showed a stronger correlation with LS-MRE (β coefficient = 0.31, p < 0.001) compared to markers related to liver fibrosis.

Conclusions

In patients without chronic liver disease and presenting with HF, elevated LS-MRE was independently associated with worse clinical outcomes. Elevated LS-MRE may be useful for risk stratification in patients with HF and without chronic liver disease.

Key Points

• Magnetic resonance elastography (MRE) is an emerging non-invasive imaging technique for evaluating liver stiffness (LS) which can estimate right atrial pressure.

• Elevated LS-MRE, which mainly reflects liver congestion, was independently associated with worse clinical outcomes in patients with heart failure.

• The assessment of LS-MRE would be useful for stratifying the risk of adverse events in heart failure patients without chronic liver disease.

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Abbreviations

APRI:

Aspartate aminotransferase to platelet ratio index

BSA:

Body surface area

C.I.:

Cardiac index

CO:

Cardiac output

CRT:

Cardiac resynchronisation therapy

FIB-4:

Fibrosis 4 index

GGT:

Gamma-glutamyl transpeptidase

HF:

Heart failure

ICD:

Implantable cardioverter defibrillator

IQR:

Interquartile range

IVC:

Inferior vena cava

LA:

Left atrial

LAVA:

Liver acquisition with volume acceleration

LS:

Liver stiffness

M2BPGi:

Mac-2 binding protein glycosylation isomer

MEG:

Motion encoding gradient

MRE:

Magnetic resonance elastography

PA:

Pulmonary artery

PCWP:

Pulmonary capillary wedge pressure

P-III-P:

Type III procollagen N-terminal peptide

RAP:

Right atrial pressure

RHC:

Right heart catheterisation

RV:

Right ventricular

RVFAC:

Right ventricular fractional area change

TAPSE:

Tricuspid annular plane systolic excursion

VAD:

Ventricular assist device

VCTE:

Vibration-controlled transient elastography

VTQ:

Virtual touch quantification

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Acknowledgements

The authors are grateful to Kinya Ishizaka for his support with analysis of MRE imaging findings.

Funding

This study has received funding from grants from the Japan Society for the Promotion of Science, Tokyo, Japan (KAKENHI no. 18K08122, Dr. Nagai), the Takeda Science Foundation (Dr. Nagai), and a Bayer Scholarship for Cardiovascular Research, the Japan Cardiovascular Research Foundation (Dr. Nagai).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Atsushi Tada, Toshiyuki Nagai, Yoshiya Kato, Kazunori Omote, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Yuta Kobayashi, Sakae Takenaka, Yoshifumi Mizuguchi, Kiwamu Kamiya, Takao Konishi, Takuma Sato & Toshihisa Anzai

  2. Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Noriko Oyama-Manabe

  3. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan

    Satonori Tsuneta & Kohsuke Kudo

  4. Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan

    Yusuke Kudo & Mutsumi Nishida

  5. Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan

    Yusuke Kudo & Mutsumi Nishida

  6. Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan

    Michikazu Nakai

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  1. Atsushi Tada
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Corresponding author

Correspondence to Toshiyuki Nagai.

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The scientific guarantor of this publication is Toshiyuki Nagai.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Michikazu Nakai kindly provided statistical advice for this manuscript.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• observational

• performed at one institution

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Tada, A., Nagai, T., Kato, Y. et al. Liver stiffness assessed by magnetic resonance elastography predicts clinical outcomes in patients with heart failure and without chronic liver disease. Eur Radiol 33, 2062–2074 (2023). https://doi.org/10.1007/s00330-022-09209-0

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