Hepatic and splenic sonographic and sonoelastographic findings in pulmonary arterial hypertension

PURPOSE To evaluate the association between sonographic, sonoelastographic and clinical cardiac parameters, and also their value in predicting survival in pulmonary arterial hypertension (PAH). METHODS Thirty-six patients with PAH and normal liver functions were prospectively enrolled in this prospective study along with 26 healthy controls, who all underwent ultrasound and "point shear wave elastography" (pSWE) examinations. Additionally, portal vein pulsatility index (PVPI), inferior vena cava collapsibility index (IVCCI), and clinical cardiac variables were obtained in PAH patients. The values of hepatic (LVs) and splenic shear wave velocity (SVs) were compared among the groups. The relationship between all sonographic and clinical parameters of the PAH patients was analyzed. Furthermore, their prognostic values in predicting survival were investigated. RESULTS The LVs values (median, 1.62 m/s) in patients were significantly higher than those of the controls (median, 0.99 m/s), while no difference was observed between SVs values. Patients with higher grades of tricuspid regurgitation (TR) were found to have significantly different values of PVPI (p=0.01) and sonoelastographic parameters compared to those of others. Tricuspid annular plane systolic excursion (TAPSE) value was found to be the only investigated parameter associated with survival (HR=0.814, 95% CI 0.694-0.954, p=0.011). CONCLUSION Our results have demonstrated a direct association of cardiac congestion with liver stiffness related to the degree of TR, and should be kept in mind during the assessment of fibrosis in patients with PAH.