Document Detail

Liver stiffness is directly influenced by central venous pressure.
MedLine Citation:
PMID:  20022130     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Liver stiffness (LS) as measured by transient elastography [Fibroscan] offers a novel non-invasive approach to assess liver cirrhosis. Since Fibroscan seems to be unreliable in patients with congestive heart failure, it remains to be determined whether hemodynamic changes affect LS irrespective of fibrosis.
METHODS & RESULTS: Using landrace pigs, we studied the direct relationship between the central venous pressure and LS measured by Fibroscan. Clamping of the inferior caval vein increased LS from 3.1 to 27.8kPa while reopening reversed LS within 5min to almost normal values of 5.1kPa. We then studied LS as a function of venous pressure in the isolated pig liver by clamping the upper and lower caval, portal vein and hepatic artery. The stepwise increase of intravenous pressure to 36cm of water column (3.5kPa) linearly and reversibly increased LS to the upper detection limit of 75kPa. We finally measured LS in 10 patients with decompensated congestive heart failure before and after recompensation. Initial LS was elevated in all patients, in 8 of them to a degree that suggested liver cirrhosis (median 40.7kPa). Upon recompensation with a median weight loss of 3.0kg, LS decreased in all 10 patients down to a median LS of 17.8kPa. Inflammation could not account for increased LS since initial liver enzyme counts were only slightly elevated and did not change significantly.
CONCLUSION: LS is a direct function of central venous pressure which should be considered when assessing the degree of fibrosis.
Gunda Millonig; Stefanie Friedrich; Stefanie Adolf; Hamidreza Fonouni; Mohammad Golriz; Arianeb Mehrabi; Peter Stiefel; Gudrun Pöschl; Markus W Büchler; Helmut Karl Seitz; Sebastian Mueller
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-04
Journal Detail:
Title:  Journal of hepatology     Volume:  52     ISSN:  1600-0641     ISO Abbreviation:  J. Hepatol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-06-08     Revised Date:  2012-08-24    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  206-10     Citation Subset:  IM    
Department of Medicine and Center for Alcohol Research, Liver Disease and Nutrition, Salem Medical Center, University of Heidelberg, Heidelberg, Germany.
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MeSH Terms
Aged, 80 and over
Central Venous Pressure / physiology*
Elasticity / physiology*
Elasticity Imaging Techniques
Heart Failure / physiopathology
Liver / blood supply*,  physiology*
Liver Cirrhosis / diagnosis*,  physiopathology
Middle Aged
Sus scrofa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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