IJCS | Volume 33, Nº3, May / June 2020

DOI: https://doi.org/10.36660/ijcs.20190005 Introduction Heart failure (HF) is a highly prevalent syndrome, affecting 1% to 2% of the world population and more than 10% of people over 70 years of age. 1-3 In Brazil, 9.3% of people older than 45 years have HF 4 and according to the BREATHE registry (Brazilian Registry of Acute Heart Failure), hospital mortality for decompensated HF is 12.6%. 5 HF is a clinical condition characterized by signs and symptoms related to systemic hypoperfusion and capillary congestion, that affect class functional status and quality of life of individuals. With increased filling pressures and damping of blood flow, the liver is affected by congestion secondary to HF. 6-9 The impact of HF on liver function was described a long time ago, and the pathophysiological relationship is confirmed by small changes in hepatic markers even in the absence of a diagnosis of liver disease. 6 In this regard, based on the various etiologies and comorbidities in HF, it becomes relevant to know the methods for assessing hepatic congestion and the mechanisms of associated injuries. Liver elastography is an imaging test that evaluates liver stiffness using an ultrasound transducer operating at 5MHz. The device transmits low-frequency vibrations 227 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2020; 33(3):227-232 Mailing Address: Diane Xavier Ávila Universidade Federal Fluminense - Cardiologia - Rua Marquês do Paraná, 303, 6º andar. Postal Code: 24030-215, Centro, Niterói - Brazil E-mail: dianeavilamed@gmail.com, dianeavilamed@yahoo.com.br Diagnostic and Prognostic Role of Liver Elastography in Heart Failure Diane Xavier Ávil a, P riscila Abreu Mato s, Gabriel Quintin o, W olney de Andrade Martin s, D almo Machad o, Claudio Tinoco Mesquit a, H umberto Villacorta Junio r Universidade Federal Fluminense, Niterói, RJ - Brazil Manuscript received January 07, 2019; revised manuscript April 24, 2019; accepted August 07, 2019. Abstract Background: Hepatic congestion is a frequent finding in patients with heart failure (HF). Physical examination has limitations in quantifying systemic congestion and requires correlation with echocardiographic and laboratory data (usually B-type natriuretic peptide, BNP, or N-terminal pro-B type natriuretic peptide, NT-proBNP). Hepatic elastography evaluates liver stiffness using a transducer that transmits low-frequency vibrations (50 Hz), and the speed of shear waves propagating through the tissues is measured by ultrasound. The faster the vibrations propagate in the hepatic parenchyma, the stiffer the liver, which, in case of HF, can be correlated with hepatic congestion. Objective: In this systematic review, case-controls, cohort studies, and randomized clinical trials were searched in MEDLINE, LILACS and Cochrane Database of Systematic Review, to evaluate the use of elastography in the detection of hepatic congestion in patients with HF. Methods: From the 49 articles retrieved, seven were selected for review, according to the inclusion and exclusion criteria. The most used methods for the diagnosis and evaluation of HF were echocardiography combined with BNP and NT-proBNP measurements. Results: Elastography performed at bedside was able to establish a significant correlation between increased liver stiffness and increased venous capillary pressure. In addition, liver elastography performed at hospital discharge was able to predict rehospitalization and mortality. Conclusion: Liver elastography is a non-invasive method that can be useful in predicting prognosis and mortality of individuals with HF, contributing to the clinical management of these patients. (Int J Cardiovasc Sci. 2020; 33(3):227-232) Keywords: Heart Failure/physiopathology; Heart Failure/mortality; Hepatic Congestion; Elastography; Ultrassonography/methods; Echocardiography/methods; Hospitalizartion; Humans.