Evaluation of hepatic congestion in patients with heart failure using shear wave and strain imaging
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Evaluation of hepatic congestion in patients with heart failure using shear wave and strain imaging Takahiro Sakamoto1,2 · Shimpei Ito2 · Shuichi Sato3 · Hiroshi Tobita3 · Akihiro Endo2 · Hiroyuki Yoshitomi4 · Kazuaki Tanabe2 Received: 6 February 2019 / Revised: 10 June 2019 / Accepted: 22 June 2019 © Japanese Society of Echocardiography 2019
This case demonstrates a new method of assessing liver congestion in a patient with heart failure (HF) through ultrasonographic (ARIETTA S70 ultrasonography system; Hitachi, Tokyo, Japan) measurement of both shear wave and strain imaging. A 47-year-old man was admitted because of HF with hypertrophic cardiomyopathy. He experienced dyspnea and weight gain for several months. His blood pressure was 95/60 mmHg; pulse rate, 67 bpm; respiratory rate, 16/min; and O2 saturation, 98% (room air). Physical examination revealed jugular venous distension, +S3, and bilateral leg edema. Radiograph revealed pleural effusion. Laboratory data showed congestive HF worsening; brain natriuretic peptide (BNP), 1302 pg/mL; and γ-glutamyl transpeptidase, 162 U/L. Inflammation or jaundice was not observed. Ultrasonography revealed left ventricular ejection fraction of 53% and early-to-late diastolic transmitral flow velocity (E/A) of 4.60. Mild mitral and tricuspid regurgitations were found. The tricuspid regurgitation pressure gradient (TRPG) was 21 mmHg; the inferior vena cava (IVC) was dilated (48 mm), without respiratory changes (Fig. 1a). The liver fibrosis (LF) index on strain imaging was 1.77 pretreatment (equivalent to estimated fibrosis stage F1–2) (Fig. 1b). Shear wave velocity (Vs) measured with shear wave imaging was 2.54 m/s (equivalent to stage F3–4) (Fig. 1c).
Optical medical therapy, including diuretics, was administered. HF was controlled after a week; dyspnea and leg edema disappeared. Body weight and BNP decreased from 74.2 to 70.2 kg and from 1302 to 619 pg/mL, respectively. E/A and TRPG remained unchanged. The IVC diameter was slightly reduced, but remained dilated (37 mm), without respiratory changes. The LF index was unchanged (1.73; Fig. 1d). Vs recovered to 1.79 m/s after decongestion (equivalent to stage F1–2) (Fig. 1e). The difference in values obtained using the two methods disappeared. This is the first report comparing the clinical utility of shear wave and strain imaging in liver congestion assessment. The case showed good adaptation of liver congestion assessment with this method, as significant congestion, but not inflammation or jaundice, was observed. The observation interval was only 1 week. Combinational elastography was properly performed, as previously reported by Yada et al. [1]. Therefore, the main cause of the reduction in shear wave imaging was most likely improvements in congestion. However, the mechanism responsible for improving Vs without improvement of the LF index and echo-derived parameters, including E/A and TRPG, after the medical treatment remains to be elucidated and verified in further large-scale pro
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