Liver stiffness measurement by transient elastography and congestion biomarkers in ambulatory heart failure
H Gonzalez CidAbstract
Introduction
Vibration-controlled transient elastography (VCTE FibroScan) has emerged as a simple, non-invasive technique with potential utility as a surrogate marker of venous congestion in patients with heart failure (HF). In this study, we sought to evaluate the association between liver stiffness measurement (LSM) and the HF biomarker profile, specifically N-terminal pro–B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen-125 (CA125), in a consecutive cohort of outpatients followed in a specialized HF clinic.
Methods
The study sample included 374 patients from April to June of 2025. LSM was obtained by a trained operator who was blinded to all clinical and biomarker data. Continuous variables are reported as medians with interquartile ranges (25th–75th percentiles), and categorical variables as counts and percentages. Differences in clinical characteristics and biomarker levels across LSM strata were assessed using the Kruskal–Wallis test, and associations were explored using Spearman's rank correlation, as appropriate. The independent relationship between LSM and circulating biomarkers was further examined using quantile regression models.
Results
The median (percentile 25% to 75%) age was 75 years (67-82), and 247 (66%) were men. Most patients were classified as stable, NYHA class I-II (93.5%), and 201 (53.7%) had left ventricular ejection fraction (LVEF) ≥50%. The medians of NT-proBNP, CA125, and LSM were 854 pg/ml (308-1932), 16 U/ml (11-29), and 5.5 kPa (3.8-9.5), respectively. Patients with NYHA III/IV displayed higher LSM (13.9 (8.3 vs 24) vs 5.4 (3.8-8.8), p<0.001. LSM was positively correlated with NT-proBNP (Spearman r=0.23, p<0.001) and CA125 (Spearman r=0.12, p=0.047). LSM was not related to age, sex, or LVEF. Multivariate analysis revealed that NT-proBNP and CA125 remained positively related to LSM (Figure).
Conclusion
In a contemporary cohort of predominantly stable outpatients with heart failure, liver stiffness measurement assessed by VTCE was independently associated with established HF biomarkers of congestion, particularly NT-proBNP and CA125, irrespective of age, sex, or left ventricular ejection fraction.LSM association with NT-proBNPFor image description, please refer to the figure legend and surrounding text.LSM association with CA125For image description, please refer to the figure legend and surrounding text.