DIAGNOSTIC EFFECTIVENESS OF DIFFERENT LIVER ELASTOMETRY METHODS IN PATIENTS WITH HEART FAILURE DEPENDING ON THE STAGE OF THE DISEASE

Abstract

Today, heart failure remains one of the most important public health problems. The leading pathogenetic mechanism of heart failure is stagnation in the systemic circulation, causing affection of one of the main target organs – the liver. Prolonged stagnation in the liver in combination with hypoperfusion of hepatocytes eventually results in liver fibrosis, followed by transformation into the so-called "cardiac cirrhosis". Biopsy with subsequent biopsy material examination remains the "gold standard" to diagnose liver damage, however, there are a number of limitations, risks, absolute and relative contraindications, due to which it is impossible to conduct an invasive diagnostic procedure in routine clinical practice settings. In recent years, medical community has paid much attention to an innovative non–invasive method of diagnosing liver fibrosis – ultrasound elastometry. To date, there are several types of this technique that are most commonly used in clinical practice: transient elastometry, point elastometry, two-dimensional shear wave elastography. Each of these methods has its advantages and disadvantages. The aim is to study and compare the diagnostic effectiveness (sensitivity, specificity and accuracy) of various types of ultrasound elastometry in diagnosing liver fibrosis in cardiac patients, depending on the stage of heart failure. Materials and methods. The study was conducted on the basis of diagnostic and minimally invasive technologies department at Clinical Hospital № 1 in Smolensk in the period from October 2022 to March 2023 Three groups of patients with heart failure were examined: Group 1 – patients with stage I of the disease (n = 12), group 2 – with stage II (n = 16), group 3 – with stage III (n = 11), a total of 39 patients. Comparative opportunities of transient liver elastometry, point elastometry and two-dimensional shear wave elastography in patients with various stages of heart failure were determined. The sensitivity, specificity and accuracy of the methods were evaluated. The methods of statistical analysis, generalization, comparison and systematization of data were used. The reference method was multispiral computed tomography with a quantitative assessment of the liver structure, biochemical blood analysis with De Ritis ratio determination and the FIB-4 scale. Results. In group 1, the sensitivity, specificity and accuracy indices did not differ statistically in 3 methods. In group 2 in transient elastometry: sensitivity made 58.1%, specificity – 67.4%, accuracy – 61.2%; in point elastometry: sensitivity made 64.7%, specificity – 82.6%, accuracy – 76.3%; in two–dimensional shear wave elastography: sensitivity made 87.4%, specificity – 93.1%, accuracy – 90.8%. In group 3, in transient elastometry, the study was uninformative, in point elastometry: sensitivity made 48.6%, specificity – 60.1%, accuracy – 52.3%; in two–dimensional shear wave elastography: sensitivity made 85.1%, specificity – 92.3%, accuracy – 88.4%. Conclusions. 1. In patients with stage I heart failure, the choice of a strictly defined elastometry technique is not fundamental, since the indicators of all three methods did not differ statistically. For patients with stage II and III heart failure, the use of shear wave elastometry is preferable, wherein at a late stage (stage III), the diagnostic effectiveness of two-dimensional shear wave elastography is higher than that of point elastometry. 2. Transient elastometry is less informative in patients with heart failure compared to shear wave elastometry.