Standardization of liver ultrasound elastometry and transthoracic echocardiography techniques for simultaneous use in patients with chronic heart failure

Abstract

Objective. To develop a standartized approach to the diagnosis of the subclinical course of chronic heart failure using a combination of transthoracic echocardiography, liver elastometry and stress test in cardiac patients.Materials and methods: All patients (n=97) were examined according to a single diagnostic algorithm: physical examination, transthoracic echocardiography and ultrasound elastometry of the liver. In addition to the main studies for patients of group No. 2 with questionable (borderline) results, according to instrumental studies, a stress test was additionally conducted to determine the latent course of heart failure. All 3 groups of patients were also dynamically examined after 3 and 6 months.Results: In patients of groups 1 and 3, the results of instrumental studies did not differ dynamically at 3 study points: 0 months — 3 months — 6 months: in patients with CHF 1 according to elastography, the indicators were within F0-F1, which corresponded to the absence of clinically significant fibrosis, for patients of group 3, the indicator It remained within F3-F4, which indicated a prolonged course of the disease, as well as venous stagnation and/or true fibrosis with subsequent transition to cirrhosis. In group No. 2 (CHF 2A-B, II–IIIFK), where a stress test was performed, the results in dynamics differed statistically significantly depending on the difference in elastometry indicators before and after physical activity: in patients with a difference of less than 15% after six months, the result remained within the same values, in a cohort of patients with a difference of 15–25% in dynamics, there was an increase in the results of liver elastometry, in the group with a difference of >25%, there was a marked increase in liver elastometry and a decrease in the left ventricular ejection fraction according to echocardiography; in addition, 45% of them have passed into the decompensation stage.Conclusion. For dynamic control of the functional state of the liver, as well as the detection of subclinical forms of CHF in cardiac patients, the use of the combined TTE+2D-SWE+test with a load test is an interesting and promising alternative to invasive manipulations, which will provide a differential approach to the diagnosis of CHF in patients at different stages of the disease.