Sound touch elastography can noninvasively evaluate liver stiffness tied to chronic heart failure, a study published January 1 in the American Journal of Cardiology found.
Researchers led by Jing-Wu Yang from Guangdong Second Provincial General Hospital in Guangzhou, China, found that patients with reduced ejection fraction and ride-sided heart failure had significantly higher liver stiffness values than control group patients.
“Sound touch elastography is a useful clinical technique … which could help patients with chronic heart failure manage their treatment regimens,” Yang and colleagues wrote.
Heart failure can affect the health of other organs. For the liver, this effect is known as cardiohepatic syndrome and includes liver congestion and hepatic artery hypoperfusion.
Sound touch elastography is a modified shear wave elastography method that uses multiple acoustic radiation force impulses to target an extended region of interest. The resulting display is a real-time colored stiffness map.
Yang's team studied liver damage in chronic heart failure patients using sound touch elastography. They included 150 patients in their study and divided them into distinct groups. These included patients with reduced ejection fraction (n = 45), mildly reduced ejection fraction (n = 40), right-sided heart failure (n = 25), and control (n = 40).
The group found that while patients with mildly reduced ejection fraction increased slightly compared with the control group patients, sound touch elastography showed significantly higher stiffness values in patients with reduced ejection fraction and right-sided heart failure.
| Liver stiffness values in chronic heart failure patients | ||
|---|---|---|
| Heart failure subgroups | Liver stiffness measurements | p-value (compared with control group) |
| Control | 5.4 kPa | N/A |
| Reduced ejection fraction | 8.4 kPa | < 0.05 |
| Right-sided heart failure | 10.3 kPa | < 0.05 |
| Mildly reduced ejection fraction | 5.9 kPa | > 0.05 |
Looking at other parameters, the team also reported that the right atrial volume index and diameter of the hepatic veins were significantly greater in the right-sided heart failure patients compared with the healthy controls.
Additionally, patients with reduced ejection fraction had lower left ventricular ejection fraction along with greater liver stiffness. Finally, patients with reduced ejection fraction and right-sided heart disease showed increased glutamyl transpeptidase and alkaline phosphatase values.
The study authors suggested that while sound touch elastography can detect and quantify the effect of chronic heart failure on the liver, liver fibrosis and severe liver congestion should also be considered in this setting.
“Our findings offer some reference for the early management of liver damage in patients with heart failure,” they wrote.
The full study can be found here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
