# Prognostic Impact of Combinational Elastography in Patients with Heart Failure

## TL;DR

This study shows that combining two types of elastography can predict heart failure outcomes by assessing liver stiffness and congestion.

## Contribution

The study introduces combinational elastography as a novel non-invasive tool for predicting heart failure prognosis.

## Key findings

- A V/L cut-off of 1.2 predicted cardiac events with 80% accuracy.
- High V/L patients had significantly higher hospitalization rates for heart failure.
- Combinational elastography is a non-invasive method for assessing hepatic congestion.

## Abstract

Background: Elastography is a non-invasive technique used to assess tissue stiffness. There are two main types of elastography: shear-wave elastography and strain imaging. Both are useful for evaluating the degree of liver fibrosis (LF). Shear-wave imaging is influenced by fibrosis and hepatic congestion, whereas strain imaging primarily reflects fibrosis progression and is less affected by congestion. We previously reported the clinical usefulness of combinational elastography in patients with heart failure (HF). However, its prognostic significance in this population remains unclear. Accordingly, in this prospective study, we aimed to evaluate the prognostic impact of combinational elastography in patients with HF. Methods: We included 77 patients with HF (median age: 79 years). Shear-wave imaging was used to obtain shear-wave velocity (Vs), whereas the liver fibrosis index (LF index) was derived from strain imaging. The Vs/LF index (V/L) was used as a prognostic indicator based on combinational elastography. Cardiac events were defined as cardiac death or hospitalization due to HF. Results: During a median follow-up of 716 days, 17 cardiac deaths or hospitalizations for HF were observed. The V/L demonstrated a cut-off value of 1.2 for predicting cardiac death or hospitalization for HF, with an area under the curve of 0.80, sensitivity of 0.82, and specificity of 0.68. Kaplan–Meier analysis demonstrated that patients with a high V/L (≥1.2) had significantly higher rates of hospitalization for HF than those with a low V/L (<1.2; log-rank test, p < 0.001). Conclusions: Combinational elastography demonstrated prognostic utility in patients with HF and may serve as a novel, non-invasive tool for assessing hepatic congestion.