The range of diagnostic possibilities of ultrasound liver elastometry in patients with chronic heart failure and diffuse changes in the live

Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure. Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method. Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%. Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible.