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Published on: July 20, 2022
Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure
Yu Sato1, Akiomi Yoshihisa1, Yuki Kanno1
1Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Insights
The Fibrosis-4 (FIB4) index, a liver stiffness marker, predicts mortality in heart failure (HF) patients. Higher FIB4 index scores correlate with increased all-cause mortality, indicating its prognostic value in HF management.
Area of Science:
- Cardiology
- Hepatology
- Prognostic Biomarkers
Background:
- Liver dysfunction in heart failure (HF), known as congestive hepatopathy, is linked to central venous pressure.
- The Fibrosis-4 (FIB4) index is a potential marker for liver stiffness, particularly in non-alcoholic fatty liver disease.
Purpose of the Study:
- To investigate the prognostic impact of the FIB4 index on all-cause mortality in patients with heart failure.
- To assess the relationship between FIB4 index, liver fibrosis markers, and cardiac function in HF patients.
Main Methods:
- A prospective study of 1058 heart failure patients categorized into three FIB4 index tertiles.
- All-cause mortality was tracked over a mean follow-up of 1047 days.
Main Results:
- All-cause mortality significantly increased across FIB4 index tertiles (12.2% to 36.6%, p<0.01).
- The FIB4 index independently predicted all-cause mortality in HF patients (p<0.05).
- Higher FIB4 tertiles showed elevated liver fibrosis markers and adverse cardiac structural/functional parameters.
Conclusions:
- The FIB4 index serves as a valuable prognostic marker for all-cause mortality in heart failure patients.
- This index may reflect underlying liver fibrosis and cardiac dysfunction contributing to HF prognosis.
Objective:
Liver dysfunction due to heart failure (HF) is known as congestive hepatopathy. It has recently been reported that liver stiffness assessed by transient elastography reflects increased central venous pressure. The Fibrosis-4 (FIB4) index (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is expected to be useful for evaluating liver stiffness in patients with non-alcoholic fatty liver disease. We aimed to investigate the impact of the FIB4 index on HF prognosis, with consideration for liver fibrosis markers and underlying cardiac function.
Methods:
Consecutive 1058 patients with HF who were admitted to our hospital were divided into three groups based on their FIB4 index: first (FIB4 index <1.72, n=353), second (1.72≤FIB4 index <3.01, n=353) and third tertiles (3.01≤FIB4 index, n=352). We prospectively followed for all-cause mortality.
Results:
During the follow-up period (mean 1047 days), 246 deaths occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from the first to third groups (12.2%, 21.0% and 36.6%, p<0.01). In the Cox proportional hazard analysis, FIB4 index was an independent predictor of all-cause mortality in patients with HF (p<0.05). In comparisons of laboratory and echocardiographic findings, the third tertile had higher levels of type IV collagen 7S, procollagen type III peptide, hyaluronic acid, left atrial volume, mitral valve E/e', inferior vena cava diameter and right atrial end systolic area (p<0.01, respectively).
Conclusion:
The FIB4 index, a marker of liver stiffness, is associated with higher all-cause mortality in patients with HF.
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