INTRODUCTION: Shear wave elastography (SWE) is widely used to assess liver stiffness in chronic liver disease. Increased stiffness may also occur in congestive liver disease (CLD) due to hepatic venous congestion in patients with cardiovascular disease, but data on its diagnostic performance remain limited. OBJECTIVES: To evaluate the diagnostic performance of SWE for detecting CLD in outpatients with structural heart disease undergoing investigation for liver disease. METHODS: Consecutive patients referred for SWE between 2018 and 2023 were retrospectively reviewed. CLD was defined by compatible liver imaging findings and structural heart disease on transthoracic echocardiography. Diagnostic performance was assessed using ROC analysis. Associations between liver stiffness and echocardiographic parameters were evaluated using correlation and partial correlation analyses, and determinants of liver stiffness were assessed using multiple linear regression. RESULTS: About 88 patients were included (17 with CLD). Liver stiffness was higher in CLD compared with non-CLD patients (8.4 7.5-9.6 vs. 7.2 6.5-8.2 kPa, p 7.54 kPa yielded an AUC of 0.757, with 81.2% sensitivity and 63.4% specificity. CLD was associated with right ventricular dilation and greater tricuspid regurgitation severity. Significant correlations were observed with right ventricular diameter, pulmonary artery systolic pressure, right atrial volume, and left atrial volume index. In multiple linear regression, CLD remained the only independent determinant of liver stiffness. CONCLUSIONS: SWE shows moderate diagnostic accuracy for detecting congestive hepatopathy in patients with structural heart disease. Liver stiffness appears to reflect systemic venous congestion rather than isolated hepatic structural disease.
Dziadzio et al. (2026) studied this question.