Evaluation of the diagnostic efficiency of instrumental index using for predicting the clinical course of chronic heart failure

Objective. To assess the potential of an integral index α, calculated from the dynamics of liver stiffness and liver density, for predicting the course of chronic heart failure (CHF).
Materials and methods. This prospective single-center study included 124 patients with CHF of NYHA functional class I–IV, who underwent standard clinical, laboratory and echocardiographic assessment, ultrasound liver elastography (2D shear-wave elastography, 2D-SWE), and non-contrast multidetector computed tomography (MDCT) of the liver at baseline, 3 and 6 months. The control group consisted of patients without clinically significant cardiac or hepatic pathology. The index α was defined as the angle between the trend lines of liver stiffness (kPa) and liver density on MDCT (HU) over time. According to the value of α, CHF patients were divided into three groups: 30–60°, 60–90° and >90°. The diagnostic performance of index α for predicting a composite adverse endpoint (death, hospitalization for decompensated CHF, increase in NYHA class by ≥1 during follow-up) was evaluated using ROC analysis.
Results. With increasing index α, a significant worsening of the clinical and instrumental status was observed: a decrease in left ventricular ejection fraction, an increase in pulmonary artery pressure, NT-proBNP level, hospitalization rate, and the severity of signs of congestive hepatopathy according to laboratory parameters, elastography, and liver MDCT (p<0.05 for most between-group comparisons). A threshold of α ≥60° was associated with a sensitivity of 85% and a specificity of 65% for identifying an unfavorable course of CHF, whereas a threshold of α ≥90° demonstrated a sensitivity of 62% and a specificity of 84%. The area under the ROC curve (AUC) for index α considered as a continuous variable was 0.82 (95% CI 0.74–0.89), indicating good prognostic performance of the proposed parameter.
Conclusions. The integral index α, based on the dynamics of liver stiffness and liver density, is associated with the severity of the clinical course of CHF and the frequency of adverse outcomes. The use of indexed α thresholds allows stratification of patients according to the risk of disease progression and may be considered a promising component of a personalized prognostic algorithm in patients with CHF.

1. Chronic heart failure. Clinical guidelines 2024 Russian Society of Cardiology. Russian Journal of Cardiology. 2024; 29 (11): 6162. (In Russ.).

2. Mascolo A., Mauro G.D., Angelis A.D. et al. Current and future therapeutic perspective in chronic heart failure. Pharmacological research. 2022; 175: 106035. https://doi.org/10.1016/j.phrs.2021.106035

3. ГGrachev D.S., Petrov V.S. High-resolution electrocardiography in chronic heart failure in the elderly. International Journal of Heart and Vascular Diseases. 2024; 12 (42): 31–38. (In Russ.).

4. Kuznecova N.O. Sagirova Zh.N., Gubina A. Yu. et al. Assessment of myocardial function in patients with chronic heart failure using a single-channel electrocardiogram recorder. Bulletin of New Medical Technologies. 2022; 29 (1): 46–52. (In Russ.).

5. Losik D.V., Fisher E.V., Mikheenko I.L. et al. The role of cardiospecific biomarkers and epicardial fat in the diagnosis of chronic heart failure in patients with various forms of atrial fibrillation. Russian Journal of Cardiology. 2022; 27 (4): 66–72. (In Russ.).

6. Shen L., Jhund P. S., Anand I. S. et al. Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction. Clinical Research in Cardiology. 2021; 110 (8): 1234–1248. https://doi.org/10.1007/s00392‑020‑01786‑8

7. Ankudinov A.S., Galsanova Zh.T.B., Zhamyandabaeva A.L.N. Second Manifestation of Arterial Disease scores during chemotherapy for malignant neoplasms in patients with chronic heart failure. News of higher educational institutions. Volga region. Medical sciences. 2025; 2 (74): 99–109. (In Russ.).

8. Arisheva O.S., Garmash I.V., Sarlykov B.K. The prevalence and prognostic significance of liver disease in chronic heart failure. Clinical Pharmacology and Therapy. 2021; 30 (1): 70–74. (In Russ.).

9. Borsukov A.V., Doroshenko D.A., Skutar A.I. Diagnostic efficiency of various liver elastometry methods in patients with heart failure depending on the stage of the disease. Acta medica Eurasica. 2023; (2): 1–13. (In Russ.).

10. Shestakova D. Yu., Borsukov A. V., Skutar A. I., Akhmedova A. R. Multiparametric ultrasound examination of the liver in overweight cardiac patients: determining the cause of fibrosis and severity of steatosis. Russian Journal of Cardiology. 2025; 30 (1): 50–57. (In Russ.).

11. Barr RG, Wilson SR, Rubens D et al. Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement. Radiology. 2020; 296 (2): 263–274. DOI: 10.1148/radiol.2020192437

12. Ivanishkina E.V., Borsukov A.V., Akulenok E.V. et al. Comorbid pathology in patients with metabolic syndrome and chronic diffuse liver diseases: possibilities of ultrasound screening and monitoring. Bulletin of the Smolensk State Medical Academy. 2025; 24 (2): 81–89. (In Russ.).

13. Kobalava Zh.D., Kokhan L.V., Safarova A.F. et al. Potential of modern investigations for detecting and monitoring asymptomatic congestion in patients with heart failure. Russian Journal of Cardiology. 2021; 26 (1): 42–65. (In Russ.). DOI: 10.15829/1560‑4071‑2021‑4265

14. Nagao K, Maruichi-Kawakami S, Aida K. et al. Association between the liver fibrosis markers and scores, and hemodynamic congestion assessed by peripheral venous pressure in patients with acute heart failure. Journal of the American Heart Association. 2023; 12 (21): e030788. DOI: 10.1161/JAHA.123.030788.

15. El-Kenawy H.A., Altuwayhir A. K.I., Fatani D. A. et al. The Overview on Congestive Heart Failure Imaging. Saudi Medical Horizons Journal. 2023; 3 (1): 21–28. https://doi.org/10.54293/smhj.v3i1.60

16. Hokkanen A., Hamalainen H., Laitinen T.M. et al. Test–Retest reliability of the assessment of fatty liver disease using Low-Dose computed tomography in cardiac patients. Frontiers in Medicine. 2021; 8: 656658. https://doi.org/10.3389/fmed.2021.656658

17. Borsukov A.V., Akhmedova A.R., Shestakova D. Yu. Patent «Method for predicting the clinical course of chronic heart failure», No. RU2842 095 C 1, registration date 19.06.2025, 14 p. (in Russ.)

18. Abdin A., Anker S.D., Butler J. et al. «Time is prognosis» in heart failure: tim-to-treatment initiation as a modifiable risk factor. ESC heart failure. 2021; 8 (6): 4444–4453. https://doi.org/10.1002/ehf2.13646

19. Skoularigkis S., Kourek C., Xanthopoulos A. et al. Prognostic Models in Heart Failure: Hope or Hype? Journal of Personalized Medicine. 2025; 15 (8): 345. https://doi.org/10.3390/jpm15080345

20. Podzolkov V.I., Dragomiretskaya N.A., Stolbova S.K., Tolmacheva A.V. Hepcidin and MELD-XI score as markers of multiple organ failure in patients with heart failure with preserved and reduced ejection fraction. Cardiovascular Therapy and Prevention. 2020; 19 (3): 2529. (In Russ.).