Liver stiffness (LS) assessed by ultrasound elastography reflects right-sided filling pressure and offers additional prognostic information in patients with acute decompensated heart failure (ADHF). However, the prognostic value of LS in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the prognostic value of LS measured by two-dimensional shear wave elastography (2D-SWE) in patients with HFpEF.

We prospectively enrolled 80 patients hospitalized for decompensated HFpEF between September 2019 and June 2020. Patients were categorized into three groups based on the tertile values of LS at discharge.

The third tertile LS group had an older age; more advanced New York Heart Association functional class; higher total bilirubin, γ-glutamyl transferase (GGT), N-terminal pro-B type natriuretic peptide (NT pro-BNP), and Fibrosis-4 index; a larger right ventricle diastolic diameter, higher tricuspid regurgitation pressure gradient, and a larger maximal inferior vena cava diameter. During a median [interquartile range] follow-up period of 212 (82-275) days, 25 (31.2%) patients suffered composite end points (all-cause mortality and rehospitalization for worsening HF). The third tertile LS group had a significantly higher rate of composite end points (log-rank P = 0.002). A higher LS and the third tertile LS were significantly associated with the composite end points, even after adjusting for a conventional validated HF risk score and other previously reported prognostic risk factors.

Increased LS measured by 2D-SWE reflects the severity of liver impairment by liver congestion and fibrosis, underlying right HF, and provides additional information for the prediction of poor outcomes in HFpEF.

通过超声弹性成像评估的肝硬度 (LS) 反映了右侧充盈压，并为急性失代偿性心力衰竭 (ADHF) 患者提供了额外的预后信息。然而，LS在射血分数保留的心力衰竭（HF）（HFpEF）中的预后价值仍不清楚。本研究旨在探讨通过二维剪切波弹性成像 (2D-SWE) 测量的 LS 对 HFpEF 患者的预后价值。

我们前瞻性招募了 2019 年 9 月至 2020 年 6 月期间因失代偿性 HFpEF 住院的 80 名患者。根据出院时 LS 的三分位值将患者分为三组。

第三个三分位 LS 组年龄较大；更高级的纽约心脏协会功能课；较高的总胆红素、γ-谷氨酰转移酶 (GGT)、N 端 pro-B 型利钠肽 (NT pro-BNP) 和 Fibrosis-4 指数；较大的右心室舒张直径、较高的三尖瓣反流压力梯度和较大的最大下腔静脉直径。在 212 (82-275) 天的中位 [四分位距] 随访期间，25 (31.2%) 名患者出现复合终点（全因死亡率和因心衰恶化而再次住院）。第三个三分位数 LS 组的复合终点发生率显着更高（对数秩P= 0.002）。较高的 LS 和第三个三分位数 LS 与复合终点显着相关，即使在调整了传统的经验证的 HF 风险评分和其他先前报告的预后风险因素之后也是如此。

2D-SWE 测量的 LS 增加反映了肝充血和纤维化引起的肝损伤的严重程度，潜在的右心衰，并为预测 HFpEF 的不良结果提供了额外的信息。