IJCS | Volume 33, Nº3, May / June 2020

Patients with liver disease and cirrhosis present higher values in HE compared to patients with cardiac disease. In general, this group was excluded from the studies that aimed at investigating patients with HF in order to avoid confounding factors. Therefore, the assessment of congestion in the presence of underlying liver disease still represents a challenge that must be overcome. Similarly to most complementary exams, HE requires good clinical correlation, especially because it does not specify the cause of increased stiffness. Fat tissue attenuates ultrasound wave propagation and, for this reason, obesity can make it difficult to perform the test. 4 Failure or inconsistent results can reach almost 20%. Factors associated with unreliable results include: BMI greater than 30 kg m 2 , age above 52 years, female sex, inexperienced operator, type 2 diabetes mellitus and ascites. Liver inflammation and steatosis may also reduce the test's accuracy. 5-7 Conclusion There seems to be a consensus that the greater the liver stiffness, the greater the risk ofmortality (“Stone liver, heart in danger”, according to Pernot and Villemain) 8 However, innumerous studies are necessary to determine which therapeutic interventions would be capable of decreasing that stiffness and whether such decrease would have a consistent impact onprognosis.Another relevant data is that we do not knowexactly the amount of information that HE can add to clinical practice, in addition to the information already provided by echocardiography and BNP. It is believed that a long way must be taken until this technique becomes a useful tool for cardiologists, with favorable impact on the management of a disease with high morbidity, mortality and cost for the healthcare system. Nevertheless, we can state that the interpretation of results by the clinician involved in the patient’s treatment will be undoubtedly crucial for its success. 1. Bamber J ,Cosgreve D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Eur J Ultrasound.2013;34(2):169-84. 2. Taniguchi T, Sakata Y, Ohtani T, Mizote I, Takeda Y, Asano Y, et al. Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am J Cardiol. 2014;113(3):552-8. 3. Ávila D, Matos PA, Quintino G, Martins WA, Machado D, Mesquita CT, et al. Diagnostic and Prognostic Role of Liver Elastography in Heart Failure. Int J Cardiovasc Sci. 2020;33(3):227-232. 4. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705-13. 5. Arena U, Vizzutti F, Corti G, Stasi C, Bresci S, Moscarella S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47(2):380-4. 6. Roulot D, Czernichow S, Le Clesieu H, Costes JL, Vergnaud AC, Beaugrand M. et al. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol. 2008;48(4):606-13. 7. Tapper, Chen E, Patel K, Bacon B, Gordon S, Lawitz E, et al. Levels of alanine aminotransferase confound use of transient elastography to diagnose fibrosis in patients with chronic hepatitis C virus infection. Clin Gastroenterol Hepatol. 2012;(8):932-7. 8. Pernot M, Villemain O. Stone Liver, Heart in Danger: Could the Liver Stiffness Assessment Improve the Management of Patients With Heart Failure? [Editorial]. JACC:Cardiovasc Imaging. 2019;12(6):965-6. References This is an open-access article distributed under the terms of the Creative Commons Attribution License 234 Hepatic Elastography in the Assessment of HF Carvalho Int J Cardiovasc Sci. 2020; 33(3):233-234 Editorial