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Elevation of Central Venous Pressure and Organ Congestion

      For the assessment of right-sided heart failure, right ventricular (RV) function is frequently evaluated, and the evaluation of central venous pressure (CVP) or right atrial pressure (RAP), which is reflective of increased RV filling pressure or elevated pre-load due to impaired RV function, is also commonly performed. Assessing IVC with echocardiography is a standard non-invasive method. However, its weak point is a semiquantitative assessment. Moreover, our report shows that body size, measured as BSA, affects the optimal cut-off level of IVC for detecting increased RAP in Japanese HF patients. Transient elastography is a noninvasive method to assess liver stiffness. Recently, using transient elastography, we have revealed that liver congestion represented as liver stiffness (LS) can estimate RAP in HF patients without liver disease. With the analysis in patients admitted due to HF, higher LS at discharge was associated with higher incidence of cardiac events. This result indicates that the presence of liver congestion at discharge may associate with poor outcomes. Elevated CVP is also associated with kidney or intestine congestion. We will introduce and discuss the association of CVP, as an indicator of right-sided heart failure, with organ congestion.
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