Hepatic elastography as a noninvasive marker of right ventricular dysfunction and prognosis in precapillary pulmonary...

Right ventricular (RV) dysfunction is a major determinant of outcomes in precapillary pulmonary hypertension (PH). Hepatic elastography may reflect systemic venous congestion and right-sided heart dysfunction, but its role in precapillary PH remains unclear.

To evaluate standard and central hepatic elastography (SHE and CHE) as noninvasive markers of right heart dysfunction and to explore their prognostic relevance in precapillary PH.

In this prospective study, 26 patients with precapillary PH underwent echocardiography and hepatic elastography. Associations between elastography and echocardiographic parameters of right heart function were assessed. Agreement between SHE and CHE was evaluated using Bland-Altman analysis, and exploratory ROC analysis identified mortality-associated thresholds.

Most patients were female (76.9%), with Group I PH (76.9%) and WHO functional class III (61.5%). SHE and CHE were strongly correlated (ρ = 0.787; p < 0.001), with no significant systematic or proportional bias on Bland-Altman analysis. Both measurements correlated with RA and RV strain, while SHE was additionally associated with TAPSE/PASP. During follow-up, four deaths occurred. Non-survivors had higher SHE and CHE values than survivors. Exploratory ROC analysis identified cutoff values of 9.64 kPa for SHE and 11.42 kPa for CHE, both showing excellent discrimination (AUC = 0.910).

Hepatic elastography was associated with echocardiographic markers of right heart dysfunction in precapillary PH. SHE and CHE showed strong agreement, supporting the feasibility of the novel central measurement approach. Larger multicenter studies are needed to determine the prognostic significance of hepatic elastography and the incremental value of CHE.