Abstract 4140549: Association of Liver Stiffness measured by Transient Elastography with All-Cause Mortality in Heart Failure patients: Trinetx Database 2015-2023

Introduction: Persistently elevated filling pressure leading to central venous congestion is associated with poor prognosis. This central venous congestion stimulates connective tissue hyperplasia causing tissue fibrosis and stiffness of the liver. However, risk stratification involving hepatic fibrosis in heart failure is limited. Research Question: Is liver stiffness associated with higher mortality in heart failure? Aims: To utilize liver stiffness measured by transient elastography as an imaging phenotype in HF risk stratification and prevention. Methods: De-identified data from 285 HF patients without pre-existing liver disease/cirrhosis, with liver stiffness measured (kPa) by transient elastography from 2015-2023 were extracted from TriNetX, a real-time, electronic, federated data network of 34 healthcare organizations. Liver stiffness was further classified as high and low with 8kPa as a cut-off. Comparisons employed the chi-square or Fisher’s exact test for categorical variables and the student’s t-test or Mann-Whitney-Wilcoxon test, as appropriate. Multivariable Cox proportional hazards models were applied to evaluate the association with mortality and readmissions in 30 days. Results: The mean age of the cohort is 65±11 years. The majority were women (57.9%). Participants were followed for a median of 3.8 (1.52-6.67) years; 83 out of 285 patients died. Multivariable analysis showed that 1 SD increase in liver stiffness was associated with increased mortality (HR 1.13, 95% CI 1.05-1.21; p<0.01) and 30-day readmissions (HR 1.13, 95% CI 1.06-1.21; p<0.01). The adjusted HR for all-cause mortality for the high liver stiffness (≥8 kPa) group was 2.30 (95% CI 1.21-4.37; p=0.01). The analysis of liver stiffness association with mortality stratified by heart failure preserved ejection fraction (HFpEF) was HR 1.14 (95% CI 1.06-1.24, p<0.01). There were no significant differences in mortality when stratified by heart failure with reduced ejection fraction, gender, and race. Conclusion: In a multi-ethnic cohort of heart failure patients with HFpEF and no preexisting cirrhosis, higher liver stiffness was independently associated with excess mortality and 30-day readmissions.