Pulmonary hypertension (PH) is a condition characterized by high blood pressure in the arteries of the lungs, which can lead to various complications, including cardiohepatic syndrome (CHS). CHS, or congestive hepatopathy, results from hepatic congestion due to PH.
Liver stiffness, quantified using shear wave elastography, may serve as an indicator of hepatic congestion. A recent study aimed to investigate whether hepatic shear wave elastography can detect patients at risk of CHS in the early stages of PH. This study was published in The Journal Of Heart and Lung Transplantation by Zvonimir A. and colleagues.

A total of 63 patients undergoing right heart catheterization (52 diagnosed with PH and 11 with invasive exclusion of PH) and 52 healthy volunteers were enrolled. Assessments included echocardiography and hepatic shear wave elastography. CHS was defined by increased levels of gamma-glutamyl transferase, alkaline phosphatase, and bilirubin. Liver stiffness was categorized as normal (≤ 5.0 kPa) or high (> 5.0 kPa).
The key findings of the study were:
• High liver stiffness correlated with impaired right ventricular (RV) and right atrial (RA) function:
• Median RV ejection fraction: 54% (interquartile range [49; 57]%) vs. 45% ([34; 51]%), p < 0.001.
• Median RA reservoir strain: 49% ([41; 54]%) vs. 33% ([22; 41]%), p < 0.001.
• High liver stiffness associated with more severe tricuspid insufficiency (p < 0.001).
• High liver stiffness linked to a higher prevalence of hepatovenous backflow: 29% vs. 2%, p < 0.001.
• Cardiohepatic syndrome (CHS) prevalence is higher in individuals with high liver stiffness: 10% vs. 2%, p = 0.038.
• In the precapillary pulmonary hypertension subgroup (n = 48):
• CHS and high liver stiffness correlated with increased European Society of Cardiology/European Respiratory Society 2022 risk scores (p = 0.003).
Shear wave liver elastography provides valuable insights into right heart function and may complement risk assessment in patients with PH. This study underscores the potential of liver stiffness as a predictor of CHS in individuals with (suspected) PH, highlighting its significance in early detection and management strategies.
Reference:
Rako, Z. A., Yogeswaran, A., Yildiz, S., Weidemann, P., Zedler, D., da Rocha, B. B., Kryvenko, V., Schäfer, S., Ghofrani, H. A., Seeger, W., Kremer, N. C., & Tello, K. Liver stiffness is associated with right heart dysfunction, cardiohepatic syndrome, and prognosis in pulmonary hypertension. The Journal of Heart and Lung Transplantation: The Official Publication of the International Society for Heart Transplantation,2024. https://doi.org/10.1016/j.healun.2024.02.013