Pulmonary hypertension (PH) can lead to congestive hepatopathy, known as cardiohepatic syndrome (CHS). Hepatic congestion is associated with increased liver stiffness, which can be quantified using shear wave elastography. We aimed to investigate whether hepatic shear wave elastography detects patients at risk in the early stages of PH. Sixty-three prospectively enrolled patients undergoing right heart catheterization (52 diagnosed with PH and 11 with invasive exclusion of PH) and 52 healthy volunteers underwent assessments including echocardiography and hepatic shear wave elastography. CHS was defined as increased levels of ≥ 2 of the following: gamma-glutamyl transferase, alkaline phosphatase, and bilirubin. Liver stiffness was defined as normal (≤ 5.0 kPa) or high (> 5.0 kPa). Compared with normal liver stiffness, high liver stiffness was associated with impaired right ventricular (RV) and right atrial (RA) function (median [interquartile range] RV ejection fraction: 54 [49; 57]% vs. 45 [34; 51]%, < 0.001; RA reservoir strain: 49 [41; 54]% vs. 33 [22; 41]%, < 0.001), more severe tricuspid insufficiency ( < 0.001), and higher prevalence of hepatovenous backflow (2% vs 29%, < 0.001) and CHS (2% vs. 10%, = 0.038). In the patient subgroup with precapillary PH ( = 48), CHS and high liver stiffness were associated with increased European Society of Cardiology/European Respiratory Society 2022 risk scores ( = 0.003). Shear wave liver elastography yields important information regarding right heart function and may complement risk assessment in patients with (suspected) PH.

中文翻译：

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肝硬化与右心功能障碍、心肝综合征和肺动脉高压的预后相关

肺动脉高压（PH）可导致充血性肝病，称为心肝综合征（CHS）。肝充血与肝脏硬度增加有关，可以使用剪切波弹性成像来量化肝脏硬度。我们的目的是研究肝脏剪切波弹性成像是否可以检测出早期PH 风险的患者。63 名前瞻性入组患者接受右心导管插入术（52 名诊断为 PH，11 名侵入性排除 PH）和 52 名健康志愿者接受了超声心动图和肝剪切波弹性成像等评估。CHS 定义为以下物质水平≥2 种升高：γ-谷氨酰转移酶、碱性磷酸酶和胆红素。肝脏硬度定义为正常（≤ 5.0 kPa）或高（> 5.0 kPa）。与正常肝脏硬度相比，高肝脏硬度与右心室 (RV) 和右心房 (RA) 功能受损相关（中位[四分位距] RV 射血分数：54 [49; 57]% vs. 45 [34; 51] %，< 0.001；RA 储存菌株：49 [41; 54]% vs. 33 [22; 41]%，< 0.001），三尖瓣关闭不全更严重（< 0.001），肝静脉回流发生率更高（2% vs 29） %，< 0.001）和 CHS（2% 与 10%，= 0.038）。在毛细血管前 PH (= 48) 的患者亚组中，CHS 和高肝硬度与欧洲心脏病学会/欧洲呼吸学会 2022 年风险评分增加 (= 0.003) 相关。剪切波肝脏弹性成像可提供有关右心功能的重要信息，并可补充（疑似）PH 患者的风险评估。