IJCS | Volume 33, Nº3, May / June 2020

229 Figure 1 - Flowchart of study selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Database: MEDLINE (n = 49) LILACS (n = 0) Scielo (n = 0) Cochrane (n = 0) n = 22 articles n = 15 articles n = 7 articles Excluded for not being related to the topic: MEDLINE (n = 27) Duplicate articles: 3 Letter:1 Editorial: 1 Case report:1 Methodology description: 1 Other exclusions: Studies on animals: 4 Studies on children: 3 Others causes: 1 tended to decreasewith clinical improvement. Natriuretic peptides are released in response to volume overload and increased pressure in cardiac cavities and their levels reflect systolic and diastolic functions, as well as right ventricular function. 14 Nishi et al. 11 found that liver stiffness correlated with preoperative severity in patients with severe HF and reflectedhepatic congestionandmaybeuseful inpredicting right atrial pressure measurement and post-operative complications in patients who underwent left ventricular assist device implantation. This was the first study to measure the variation of liver stiffness and its relationship with clinical outcome and laboratory data, including BNP levels. 11 Lindvig et al. 13 observed a high value of liver stiffness at admission associated with increased mortality, hepatic cirrhosis and congestive HF, with a mortality rate of 20.8% in patients with transient elastography greater than 8.0 kPa. Taniguchi et al. 12 suggested liver stiffness as a systemic volume index and predictor of HF severity, similarly toAlegre et al., 7 who also reported an association of hepatic congestion with worsening of patient outcome. An important finding of these reports was the fact that the volume withdrawal by diuretic therapy or hemodialysis did not alter the values of elastography at short time. 7 Another study showed an improvement in elastographic values even though they did not reach standards of normality after cardiac decompensation. 14 Discussion Increased filling pressure of the right cavities can result in venous congestion, which is considered a determinant factor for systemic injury, cirrhosis and death. 8,11 Elastography is a method that has been recently used to evaluate hepatic congestion. It is a painless, quick (< 10 minutes in the bedside), safe examination, and that has a good acceptance by patients, especially in case of repeated examinations. 15 Despite increasing evidence of the benefits of this method in the management of patients with HF, elastography is still little explored. The cutoff values of BNP and NT-proBNP for the diagnosis of acute HF have Ávila et al. Hepatic elastography in heart failure Int J Cardiovasc Sci. 2020; 33(3):227-232 Original Article