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DOI: 10.1055/s-0029-1246547
Valsalva and orthostatic maneuvers increase liver stiffness (Fibroscan®) in healthy volunteers
Background and Objective: Liver stiffness (LS) has emerged as novel noninvasive parameter to screen for liver cirrhosis. However, other factors such as venous pressure also increase LS independent of fibrosis stage and no normal LS has been defined yet. Our aim was to study physiological conditions such as position changing and breath maneuvers on LS.
Results and Methods: Measuring LS in reclined position yields the lowest and most reproducible LS of 4.7 kPa±1.3 kPa. Upright position and Valsalva maneuver independently increased LS with an enormous variability. In 20% of individuals, sitting and standing position increased LS over 8 kPa, in some persons up to 43 kPa. Additional Valsalva maneuver increased LS in all test persons in sitting position (p=0.007), in some individuals up to 72 kPa. Individuals with a significant increase of LS in standing position also showed increased LS in one of the Valsalva maneuvers. Male gender was the only parameter that correlated significantly with increased LS during Valsalva in reclined position, but not BMI, age, or hemodynamic parameters.
Conclusion: Orthostasis and Valsalva maneuver drastically increase LS in healthy test persons. Our study indicates that a) the intraabdominal pressure is an important determinator of LS and b) a reclined position and normal breathing gives the lowest and most reproducible LS values (<6 kPa).