Multiparametric ultrasound liver examination in cardiological overweight patients: determining the cause of fibrosis and severity of steatosis

Aim. To evaluate the feasibility of using multiparametric liver ultrasound to determine the pathophysiological causes of increased stiffness in patients with cardio-metabolic risks.

Material and methods. A study was conducted involving 104 cardiology patients, including 48 men (46,2%) and 56 women (53,8%), aged 49 to 73 years, of Caucasian ethnicity. Inclusion criteria included chronic heart failure stage IIB (II, III functional classes according to NYHA), main and additional criteria of metabolic syndrome containing cardiometabolic risks for the development of metabolically associated fatty liver disease. All patients were examined according to a unified diagnostic algorithm consisting of two stages: Stage 1 — clinical and laboratory assessment, Stage 2 — instrumental assessment using liver ultrasound methods (B-mode, color Doppler imaging, two-dimensional shear wave elastography, quantitative steatometry).

Results. A scoring system has been proposed to assess the predominant contribution to liver fibrosis development based on data from multiparametric ultrasound examination of the liver. Total score 0-8: predominant liver involvement — in this case, characteristic signs of liver involvement, such as increased echogenicity and absence of significant venous vessel dilation, are observed. Total score 9-14: combined involvement — the signs include both liver-related changes (e.g., steatosis) and signs of venous congestion. Total score 15-16: predominant cardiovascular involvement — in this case, significant venous vessel dilation and other signs of congestive hepatopathy are the main features, indicating venous congestion as the primary cause of liver changes.

Conclusion. Multiparametric ultrasound examination of the liver combined with the developed scoring system can be used to differentiate the causes of increased liver stiffness and the severity of liver steatosis in patients with cardiometabolic risks. Standardization of the ultrasound protocol improves the reproducibility of the method.

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