| Objective Ejection fraction preserved heart failure(HFpEF)is a common clinical syndrome with a high morbidity,accounting for approximately 50%of all heart failure patients,and a mortality comparable to that of ejection fraction reduced heart failure(HFrEF).Secondary liver fibrosis is very common in patients with heart failure,but the relationship between liver fibrosis and HFpEF remains unclear.The purpose of this study was to measure the degree of liver fibrosis by liver elastography,and to explore the correlation between liver fibrosis and the severity of HFpEF disease.Method A total of 150 patients with ejection fraction preserved heart failure(HFpEF)admitted to the first affiliated hospital of soochow university from December 2018 to December 2019 were selected.On admission,all patients were examined by liver transient elastography.According to the value of elastic modulus,they were divided into low hardness group(50 cases),medium hardness group(50 cases)and high hardness group(50 cases)by three-point method.The cardiac function,left ventricular diastolic function,left ventricular remodeling degree,right cardiac function and short-term prognosis(≤1 year)of the three groups were compared,and the correlation between liver elasticity and each indicator was analyzed.Results The elasticity of the liver was abnormally high in more than two-thirds of case.The proportion of NYHA class III-IV in the high-hardness group was significantly higher than that in the low-hardness group(96%vs.70%,P=0.013).There were significant differences in the level of Log NT-proBNP between the three groups(2.63±0.65vs.2.84±0.44vs.3.05±0.71,P=0.027).In terms of diastolic function and left ventricular remodeling,the ventricular septal e’(5.01±2.69vs.6.48±2.29,P=0.025),side wall e’(6.63 ± 3.50vs 8.62±2.73,P=0.013),mean E/e’(20.06±7.53vs 13.20±6.05,P=0.001),left atrial volume index(43.53±10.94vs.35.78±13.86,P=0.008),tricuspid regurgitation peak velocity(3.16±0.44vs.2.75±0.50,P<0.001),left ventricular mass index(male)(163.2±47.6vs.131.3±38.0,P=0.015),and left ventricular mass index(female)(147.4±48.6vs.110.6±24.3,P=0.036)was significantly different between the high-hardness group and the low-hardness group.Spearman correlation analysis showed that liver elasticity was significantly associated with the indicators above(P<0.05).The proportion of patients with diastolic dysfunction in the high-hardness group was significantly higher than that in the low-hardness group(70%vs.36%,P=0.017).In terms of right heart function,RV fractional area change(RV FAC)(30.3±5.4vs.36.5±6.8,P<0.001),tricuspid annular plane systolic excursion(TAPSE)(7.7±5.2vs.14.8±5.9,P=0.010),pulmonary artery systolic pressure(PASP)(38.0±10.5vs.32.4±10.3,P=0.005),tricuspid regurgitation(TR)peak systolic velocity(3.16±0.44vs.2.75±0.50,P<0.001),inferior vena cava diameter(2.53±0.51vs.198±0.41,P<0.001),and proportion of inferior vena cava collapsibility<50%(86%vs.46%,P=0.011)all showed significant differences between the high-hardness group and the low-hardness group.Spearman correlation analysis showed that liver elasticity was significantly associated with right atrial diameter(r=0.205,P=0.034),RV FAC(r=-0.398,P<0.001),TAPSE(r=-0.306,P=0.002),PASP(r=0.485,P<0.001),and TR peak systolic velocity(r=0,566,P<0.001).More than half(55%)of HFpEF patients with right ventricular dysfunction(RVD)still had abnormal liver elasticity.Compared with HFpEF without RVD,HFpEF with RVD had higher male sex(53.6%vs.30.3%,P<0.001),higher NYHA grade(3.2±0.6vs.2.8±0.6,P=0.010),higher proportion of atrial fibrillation(45.2%vs.18.2%,P<0.001),and higher liver elasticity(7.95±0.60vs.7.31±0.84,P=0.003).In terms of short-term prognosis,the incidence of adverse cardiovascular events(including re-hospitalization for heart failure)was significantly higher in the high-hardness group than in the medium-hardness group(P=0.008)and the low-hardness group(P=0.003).Multivariate Cox proportional hazard analysis showed that adverse cardiovascular events were independently associated with NYHA grade,atrial fibrillation,Log NT-proBNP,and liver hardness values(HR=1.208,95%ci 1.115-1.352,P=0.002).Conclusion Liver fibrosis is common in HFpEF patients.Increased liver fibrosis in HFpEF patients was significantly associated with the worse left diastolic function,left ventricular remodeling,and the right heart function.But liver fibrosis in HFpEF patients may be more than the result of fluid dysfunction in the right heart.Male,atrial fibrillation,poorer NYHA class,and increased liver fibrosis were significantly associated with HFpEF with right heart dysfunction.Increased liver fibrosis was significantly associated with worse one-year re-hospitalization for heart failure in HFpEF.Atrial fibrillation,poor NYHA class,higher NT-proBNP,and increased liver hardness were independent predictors of poor prognosis. |
PDF Full Text Request