IJCS | Volume 33, Nº3, May / June 2020

231 1. Ceia F, Fonseca C, Mota T, Morais H, Matias F, de Sousa A, et al. Prevalence of chronic heart failure in Southwestern Europe: the EPICA study. Eur J Heart Fail. 2002;4(4):531-9. 2. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289(2):194-202. 3. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. 2004;25(18):1614-9. 4. Jorge AJL, Rosa MLG, Fernandes LCM, Freire MDC, Correia DMS, Rodrigues RC, et al. Heart failure prevalence study among patients enrolled in the family health program, Niterói. The DIGITALIS Study: design and method. Rev Bras Cardiol. 2011;24(5):320-5. 5. Albuquerque DC, Neto JD, Bacal F, Rohde LE, Bernardez-Pereira S, Berwanger O, et al. I Brazilian Registry of Heart Failure - clinical aspects, care quality and hospitalization outcomes. Arq Bras Cardiol. 2015;104(6):433-42. 6. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, RedfieldMM. Trends in Prevalence and outcome of heart failurewith preserved ejection fraction. N Eng J Med. 2006;355(3):251-9. 7. Alegre F, Herrero JI, Iñarrairaequi M, Gavira JJ, Pujol C, Montero A, et al. Increased liver stiffness values in patients with heart failure. Acta Gastroenterol Belq. 2013;76(2):246-50. 8. Hopper I, Kemp W, Porapakkham P, Sata Y, Condon E, Skiba M, et al. Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography. Eur J Heart Fail. 2012;14(6):621-7. References mentioning, however, that liver elastography is an examiner-dependent method which requires adequate training. Furthermore, there is no standardization in the analysis of the results. Patients with liver disease and cirrhosis have higher elastography values than patients with other chronic diseases and were then excluded from the studies to avoid confounding factors. There was a divergence on whether liver stiffness improves with diuretic treatment compared with elastography in a short period of time, which shows the importance of a long-term follow-up, since this could have a positive impact on morbimortality. In addition, it is believed that elastography can be used as a response tool to clinical or supportive therapy, or as a prognostic tool in HF treatment. Conclusion Data on the use of elastography in the evaluation of patients with different stages of HF, such as stable, acute or chronic decompensated HF, and of patients undergoing left ventricular assist device implantation is still scarce and more data are needed. The method seems to increase the diagnostic power of the elevation in the filling pressures of the right cavities and, consequently, increased liver stiffness. The effects of heart disease on liver function may be silent, not detected by physical examination or laboratory tests, and in this context, elastography seems to be the ideal non-invasive method for assessing liver damage caused by cardiovascular disease. This analysis can help in the clinical management of these patients and be of prognostic value at hospital discharge. Author contributions Conception and design of the research: Avila DX. Acquisition of data: Avila DX, Lopes GQ, Matos PA. Analysis and interpretation of the data: Avila DX, Matos PA, Martins WA, Villacorta H, Mesquita CT, Machado D. Statistical analysis: Avila DX, Machado D. Writing of the manuscript: Avila DX, Matos PA. Critical revision of the manuscript for intellectual content: Avila DX, Martins WA, Villacorta H, Mesquita CT. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of master submitted by Diane Xavier de Ávila, from Fluminense Federal University. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. Ávila et al. Hepatic elastography in heart failure Int J Cardiovasc Sci. 2020; 33(3):227-232 Original Article