Splenic stiffness as a new marker of congestion in the systemic circulation in patients with acute decompensation of chronic heart failure
Abstract. Approximately 90% of hospitalizations for heart failure (HF) are due to manifestations of venous congestion, but the pathophysiological mechanisms underlying it remain incompletely understood and are insufficiently taken into account in clinical practice. The aim: to study the role of spleen stiffness (SS) in the assessment of systemic venous congestion in patients with acute decompensation of chronic HF (ADCHF). Material and methods. The study included 77 patients (44 women and 33 men) with ADCHF aged 73.5 ± 7.7 years. All patients underwent standard physical, laboratory, and instrumental examinations, including NT-proBNP, lung ultrasound, bioimpedance vector analysis, indirect transient elastography of the spleen and liver using the FibroScan device, echocardiography, and assessment of congestion severity according to the VExUS protocol on the Philips Epiq7 device. Depending on SS values, patients were divided into two groups: those with SS below and above the median value (< 36.1 kPa and ≥ 36.1 kPa, respectively). Results. When comparing groups depending on the median value, in the group of patients with SS ≥ 36.1 kPa, dyspnea at rest and paroxysmal nocturnal dyspnea were more frequently detected (p <0.05), and there was a tendency for an increased frequency of lung rales and hepatojugular reflux. In this same group, more pronounced signs of hypervolemia were noted: a larger amount of extracellular fluid according to BIVA data, a higher frequency of IVC dilation, and increased diameters of the portal, hepatic veins, and IVC, as well as a predominance of severe degrees of venous congestion according to the GRADE scale (p <0.05). A statistically significant direct association between SS and liver stiffness was revealed (r = 0.46, p <0.001), as well as a connection with variants of cardiorenal syndrome. In the assessment of echocardiographic parameters, larger right atrial sizes were recorded and severe tricuspid regurgitation was significantly more often diagnosed (p <0.05). Conclusion. Increased SS ≥ 36.1 kPa is associated with a more severe heart failure phenotype, predominantly with congestion in the systemic circulation, which allows this indicator to be considered a new marker of venous congestion in patients with ADCHF.К. Кhalilova, I.A. Misan, W.B. Guzman Curay, Zh.D. Kobalava
Keywords
splenic stiffness
venous congestion
cardio-splenic axis
heart failure
splenic elastography
References
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About the Authors
Kamila Khalilova, postgraduate student, research intern of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Institute of medicine, RUDN University, Moscow, Russian Federation.E-mail: kamila.29@inbox.ru
ORCID: https://orcid.org/0009-0000-6967-4909
Irina A. Misan, MD, PhD (Medicine), assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Institute of medicine, RUDN University, Moscow, Russian Federation.
E-mail: irina.misan20@gmail.com
ORCID: https://orcid.org/0000-0002-3223-128X. eLibrary SPIN: 2273-4624
Wellington B. Guzman Curay, clinical resident of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Institute of medicine, RUDN University, Moscow, Russian Federation.
Zhanna D. Kobalava, MD, Dr. Sci (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseev of the Institute of medicine, RUDN University, Moscow, Russian Federation.
E-mail: zkobalava@mail.ru
ORCID: 0000-0002-5873-1768. Scopus ID: 59074008600. eLibrary SPIN: 9828-5409
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