Abstract 9435: An Ultrasound Image of Spleen Shear Wave Elastography Predicts Adverse Outcomes in Heart Failure Patients

Abstract

Introduction: Cardiac and multiple organ network is involved in the pathophysiology of heart failure (HF). Ultrasound shear wave elastography (SWE) is a novel non-invasive imaging that is capable of quantitatively and directly estimating tissue stiffness, but its significance of the spleen has not been fully investigated, and the interactions between the heart and the spleen are poorly understood. This study aimed to clarify the clinical relevance of the spleen in HF patients by splenic ultrasonographic evaluation. Methods and Results: We applied the two-dimensional SWE of the spleen in consecutive hospitalized 232 patients with HF. We also measured spleen shear wave dispersion (SWD) to evaluate the tissue viscosity as well as the spleen index to assess the splenic size. In comparison to non-HF patients (n = 35), spleen SWE and SWD were significantly increased in HF patients (2.18 ± 0.28 vs. 2.38 ± 0.54 m/s, P = 0.03 and 11.3 ± 3.4 vs. 13.9 ± 5.3 m/s, P < 0.01, respectively) but spleen index did not differ between the two groups (24.1 ± 8.2 vs. 24.4 ± 9.8, P = NS). In HF patients, spleen SWE was negatively correlated with right ventricular fractional area change (P = 0.01) and positively correlated with the 7S domain of collagen type IV, a marker of fibrosis (P = 0.01). During a mean follow-up period of 303 days, the Kaplan-Meier analysis demonstrated that a higher spleen SWE was associated with a lower cardiac event-free rate from cardiac deaths and decompensated heart failure ( Figure ), but spleen SWD or spleen index was not. A multivariable Cox proportional hazard analysis revealed that spleen SWE was an independent predictor for the cardiac events (hazard ratio 3.4, P < 0.01). Conclusion: Among the splenic ultrasonographic parameters, spleen SWE was strongly associated with adverse outcomes in HF patients accompanied by organ fibrosis and right ventricular dysfunction.