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Liver stiffness and hepatic comorbidities in patients with chronic heart failure

Diane Xavier de Avila, Carolina Martins Cabrita Lemos, Ricardo Santos, Thais Andrade Guarana, Ronaldo Altenburg O C Gismondi, Luis Otavio Cardoso Mocarzel, Humberto Villacorta

Objective: To evaluate the prevalence of associated hepatic diseases, previously known or not, in patients with established HF diagnosis, followed in a specialized outpatient clinic.

Methods and results: It was an observational study. Patients underwent clinical evaluation, functional class determination, cardiopulmonary, abdominal and lower limbs examination thus laboratory. Transthoracic echocardiography was performed in all patients. The patients were also submitted to hepatic elastography (HE) and, when altered, submitted to abdominal ultrasonography evaluation, to exclude or confirm the presence of liver diseases. Sixty-eight patients (71.6%) had hepatitis A. Two patients (2.1%) had positive serology for the hepatitis C virus and ten (10.5%) for hepatitis B virus and sixteen (16.8%) were protected by hepatitis B vaccine. All patients with liver stiffness (LS)>7.0 kpA, who were twenty-eight (29%), underwent abdominal ultrasonography. The median LS for the entire population was 6.3 (interquartile range 2.5-41.2) kPa. LS correlated with NT-proBNP (r=0.35, p<0.002), total bilirubin (r=0.44, p<0.0001), direct bilirubin (r=0.49, p<0, 0001), alkaline phosphatase (r=0.38, p<0.0001), and GGT (r=0.49, p<0.0001).

Conclusion: We found a low frequency of hepatic comorbidities in patients with chronic HF. In addition, we found a large number of patients with altered LS evaluated by HE that was not associated with liver diseases, suggesting that these results are due to hepatic congestion.