Quantitative assessment of renal stiffness with shear wave elastography in heart failure: a prospective study

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OBJECTIVE: To evaluate the diagnostic value of ultrasonography (US) and shear wave elastography (SWE) in detecting early renal parenchymal changes in patients with congestive heart failure (CHF) with preserved or mildly impaired renal function. METHODS: This prospective study included 53 patients with CHF patients and 40 age- and demographic-matched healthy controls. Kidney length and cortical thickness were evaluated by US, and parenchymal stiffness was measured using SWE. Subgroup analyses were conducted based on ejection fraction (EF). Correlation and regression analyses assessed associations between imaging findings and laboratory parameters. RESULTS: Kidney length and cortical thickness were significantly lower in CHF patients than controls (P < .05) but remained within normal limits. No significant differences were observed between patient subgroups (P > .05). Parenchymal stiffness was significantly higher in CHF patients (right: 6.5 ± 1.6 kPa; left: 6.4 ± 2.0 kPa) compared to controls (right: 4.8 ± 0.4 kPa; left: 4.9 ± 0.5 kPa; P < .001), with subgroup differences by EF (P < .01). ROC analysis identified optimal SWE thresholds of 5.05 kPa (right) and 5.03 kPa (left), with sensitivities of 78% and 80% and specificities of 69% and 70%. Regression analysis showed GFR (β = -.48, P < .001) and comorbidities (β = .397, P = .010) independently predicted stiffness, whereas EF, pro-BNP, and creatinine did not. CONCLUSIONS: SWE can detect subclinical renal changes in CHF before functional deterioration, offering a non-invasive biomarker for early diagnosis and personalized treatment strategies. ADVANCES IN KNOWLEDGE: SWE may provide earlier detection of parenchymal alterations than conventional US.

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