Hasan Koca1, Ayse Selcan Koc2, Hilmi Erdem Sumbul3, Mevlut Koc4. 1. Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey. hasankoca90@hotmail.com. 2. University of Health Sciences - Adana Health Practice and Research Center. drayseselcankoc@gmail.com. 3. Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey. erdemsumbul@gmail.com. 4. Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey. mevlutkoc78@yahoo.com.
Abstract
AIMS: Liver stiffness (LS) is associated with central venous pressure and pericardial effusion (PE) may be associated with these increased pressures. The aim of this study was to investigate the change in LS obtained by liver elastography (LE) in patients with severe PE and its usefulness for the diagnosis of cardiac tamponade. MATERIALS AND METHODS: Forty-patients with severe-PE were included in this study. All patients underwent LE examination in addition to echocardiography. Patients were divided into 2 groups: with and without cardiac tamponade. RESULTS: In patients with cardiac tamponade, LS values, inspiratory-expiratory vena cava inferior (VCI) diameters and presence of <50% inspiratory-VCI collapse was significantly higher. LS value and inspiratory-VCI diameter before pericardiocentesis independently determined the risk of cardiac tamponade. Each 1kPa increase in LS value and 1mm increase in inspiratory-VCI diameter increased the risk of cardiac tamponade by 4.9-times and 40.8%, respectively. When the cut-off value of 10kPa for LS was analyzed, it determined the presence of cardiac tamponade with ≥90% sensitivity and specificity. The higher LS before pericardiocentesis and the decrease in LS after pericardiocentesis (Δ-Liver stiffness of 5.91±1.79 kPa in first group and 2.31±1.25 kPa in the second group) was interpreted to be directly related to the pathophysiology of systemic congestion due to PE. CONCLUSION: In all patients with severe PE, and especially in patients with cardiac tamponade, the LS is significantly increased and this modification can be explained by the systemic congestion. However, this being the first study to evaluate LS in patients with severe PE and cardiac tamponade, the data should be confirmed by multicenter prospective studies.
AIMS: Liver stiffness (LS) is associated with central venous pressure and pericardial effusion (PE) may be associated with these increased pressures. The aim of this study was to investigate the change in LS obtained by liver elastography (LE) in patients with severe PE and its usefulness for the diagnosis of cardiac tamponade. MATERIALS AND METHODS: Forty-patients with severe-PE were included in this study. All patients underwent LE examination in addition to echocardiography. Patients were divided into 2 groups: with and without cardiac tamponade. RESULTS: In patients with cardiac tamponade, LS values, inspiratory-expiratory vena cava inferior (VCI) diameters and presence of <50% inspiratory-VCI collapse was significantly higher. LS value and inspiratory-VCI diameter before pericardiocentesis independently determined the risk of cardiac tamponade. Each 1kPa increase in LS value and 1mm increase in inspiratory-VCI diameter increased the risk of cardiac tamponade by 4.9-times and 40.8%, respectively. When the cut-off value of 10kPa for LS was analyzed, it determined the presence of cardiac tamponade with ≥90% sensitivity and specificity. The higher LS before pericardiocentesis and the decrease in LS after pericardiocentesis (Δ-Liver stiffness of 5.91±1.79 kPa in first group and 2.31±1.25 kPa in the second group) was interpreted to be directly related to the pathophysiology of systemic congestion due to PE. CONCLUSION: In all patients with severe PE, and especially in patients with cardiac tamponade, the LS is significantly increased and this modification can be explained by the systemic congestion. However, this being the first study to evaluate LS in patients with severe PE and cardiac tamponade, the data should be confirmed by multicenter prospective studies.