Abstract 11296: Non-Invasive Assessment of Liver Stiffness in Pulmonary Hypertension Patients - A New Marker for Right Ventricular Dysfunction

Abstract

INTRODUCTION - Right ventricular dysfunction (RVD) is an important indicator of a poor Pulmonary Hypertension (PH) prognosis. Cardio-hepatic interaction in left heart failure (LHF) is discreet, however, research is lacking in right heart failure (RHF). The study rationale is that PH patients can evolve to RHF with increased pressure in right chambers and passive hepatic congestion, consequently leading to an increase in liver stiffness (LS). OBJECTIVE - Assess LS in precapillary patients compared to a healthy control group. METHODOLOGY - A transversal pilot study conducted from January 2020 to April 2022 with precapillary PH patients over age 18, diagnosed by right heart catheterization. Postcapillary PH secondary to schistosomiasis, liver disease and alcoholism were excluded. Results were paired with a healthy control group. Both groups underwent two-dimensional speckle tracking with strain echocardiogram (ECO) and shear wave hepatic elastography (HE) on a Phillips ultrasound. HE measurements were taken at two points; standard (SHE), supported by literature and widely used, and a central (CHE), located near the hepatic thread. In addition, the PH group underwent laboratory exams: liver function, BNP dose, complete blood count and kidney function. Results: PH group 31 patients: 26 women (84%) and 5 men (16%); average age 51.7 (24-81 years). PH group etiology: group I (63%), group IV (22.6%) and group III (16%). Degree of dyspnea: III (74%), II (16%) and I (6%). Control group 15 individuals: 10 women (67%) and 5 men (33%): 45.7 average age (27-61 years). PH group SHE median 5.93Kpa, IQR: 5.87, versus 3.69kpa for the control group (p<0.001) with IQR 0.82kpa. While PH group CHE was 8.03Kpa: IQR 6.10Kpa (p<0,001) versus 5.15Kpa, IQR 1.60Kpa in the control group. ECO parameters in PH patients, only the right ventricle free wall strain presented a moderate correlation with SHE, Pearson coefficient of -0.427 p<0.019. There is a high correlation between SHE and CHE, Pearson coefficient 0.887 p<0.001. PH group lab results did not indicate correlation with ECO nor HE. CONCLUSION: HE can be used as a new marker for RVD in PH patients.