Z Gastroenterol 2009; 47 - P5_19
DOI: 10.1055/s-0029-1191981

Increased venous pressure increases liver stiffness (Fibroscan) independent of liver fibrosis

G Millonig 1, S Friedrich 1, S Adolf 1, G Pöschl 1, P Stiefel 1, HK Seitz 1, S Mueller 1
  • 1Alkoholforschungslabor und Medizinische Klinik, Salem Krankenhaus, Heidelberg

Aims: Transient elastography is a novel non-invasive tool to assess liver fibrosis/cirrhosis. However, it remains to be determined if other conditions such as increased venous pressure e.g. due to congestive heart failure may interfere with fibrosis assessment.

Study design: We studied 20 patients with subacute decompensation of congestive heart failure. Patients were evaluated at admission and after recompensation mostly by diuretic treatment. Body weight, vena cava diameter in inspiration and expiration, circulating pro-NT-BNP levels and liver stiffness (kPa) were correlated before and after treatment of congestive heart failure.

Results: Initially elevated liver stiffness (LS) decreased in 19 out of 20 patients, in 16 of them markedly. In 14 patients LS was elevated to a degree that suggested liver cirrhosis (mean 17.4 kPa). Successful diuretic therapy with a mean weight loss of 5kg over 8 days led to a significant decrease in LS (mean decrease 9.6 kPa). In all patients a decrease of LS correlated highly with weight loss and decreased pro-NT-BNP levels. The four patients who did not reach normal LS values despite adequate diuretic therapy and weight loss had a long history of right heart failure and two of them even showed signs of cirrhose cardiaque with esophageal varices. To further prove that increased venous pressure has a strong impact on LS we evaluated 20 healthy individuals before and during a Valsalva maneuver. Stiffness values increased significantly from a median of 3.5kPa to 7 kPa (p=0.008). Single individuals were able to increase their LS from normal values up to values suggesting cirrhosis (>12 kPa).

Conclusion: Increased venous pressure by congestive heart failure or a Valsalva maneuver strongly interferes with liver fibrosis assessment using transient elastography (Fibroscan). Therefore, fibrosis assessment by Fibroscan should include standard measuring positions and the exclusion of right congestive heart failure.

Fibroscan - Fibrosis - Valsalva - cirrhosis - diagnosis - heart failure