Prognostic value of liver stiffness in patients with heart failure: a systematic review and meta-analysis

AIMS: Heart failure (HF) is a complex, multisystemic condition affecting 64 million people worldwide and often leads to cardio-hepatic syndrome due to venous congestion and ischemic liver changes. Liver stiffness (LS) measured through elastographic methods has emerged as a potential noninvasive marker for cardiac outcomes in HF patients. However, its prognostic value and the implications for LS cutoff values remain uncertain, necessitating further investigation. METHODS: Multiple databases (PubMed, Embase, Scopus and the Cochrane Library Database) were searched up to 1st September 2024. Two reviewers screened records and extracted data according to the inclusion and exclusion criteria. The methodological quality was evaluated using the National Heart, Lung and Blood Institute (NHLBI) for observational cohort and cross-sectional studies. The meta-analysis was performed using RevMan 5.4 and the meta-regression and publication bias analyses (including Egger's and Rank-correlation tests) were performed using JASP software, version 0.19.1. RESULTS: Thirty-four studies involving 3753 individuals were included in our qualitative assessment, while 11 studies involving 1085 patients were included in the quantitative assessment. Elevated LS was significantly associated with adverse cardiac events in both acute decompensated HF (ADHF, hazard ratio (HR): 1.04, 95% CI: 1.01-1.07; I² = 61%) and chronic HF (CHF, HR: 1.09, 95% CI: 1.04-1.13; I² = 81%). Meta-regression revealed that LS cutoff values did not influence pooled estimates, and heterogeneity likely stemmed from demographic and methodological differences. CONCLUSION: Increased LS is associated with poor outcomes in patients hospitalized for HF, with a greater overall effect size in the CHF group than in the ADHF group. The LS is a promising noninvasive marker of liver congestion in HF and may aid both therapeutic decision-making and prognostication.