A composite noninvasive index correlates with liver fibrosis scores in post-Fontan patients: Preliminary findings

Abstract

Objective: We hypothesized that clinic-based, hepatic-ultrasound, elastography measurements, either alone or in combination with other noninvasive variables, might correlate with liver-biopsy fibrosis scores in patients post-Fontan. Results: We identified a total of 79 post-Fontan patients that underwent cardiac catheterization and liver biopsy. Of the 79 patients, 53 met inclusion criteria, and 32 consented to undergo hepatic-ultrasound elastography. Of the 32 that underwent elastography, data from 30 patients was used for analysis. We found no statistically significant differences in demographics, laboratory values, or cardiac catheterization data between the 30 included patients and the 21 that did not participate. Utilizing data from the 30 included patients, we found a strong, highly statistically significant correlation between the Fontan hepatic index values and total fibrosis scores (R 5 0.8, P < .00001). However, the cohort size prevented reliable discriminating cut-off values for the range of total fibrosis scores.Conclusions: In a small cohort of patients post-Fontan, preliminary findings suggest that the composite Fontan hepatic index might be a clinically useful, noninvasive method of serially monitoring for hepatic fibrosis. Further studies, with large patient cohorts, are necessary to validate our findings and develop clinically useful discriminatory cutoff values. K E Y W O R D SFontan, hepatic fibrosis, shear-wave elastography

Fontan venovenous collaterals and hepatic fibrosis

“…We also found that, similarly, ultrasound, shear-wave elastography scores were higher in those with venovenous collaterals vs those without col- past studies failed to show a statistically significant effect from a range of inferior vena caval pressures on either TFS or FPR. 17,20 Additional strengths include our robust data management and electronic health records on all diagnosed patients in Nevada, avoiding the reliance on third-party sources such as hospital discharge information or state databases. Finally, data were culled from a relatively young, stable population.…”

“…16 We previously demonstrated the better correlating strength for the TFS than individual portal or sinusoidal fibrosis scores, when compared with variables such as laboratory values, hemodynamic measurements, and elastography scores. 17 For each patient, we calculated a value for the hepatic fibrosis EVANS ET AL.…”

Liver disease secondary to congenital heart disease in children

“…The diagnostic accuracy of the FibroScan system for hepatic fibrosis has been validated in chronic viral hepatitis and nonalcoholic fatty liver disease. However, evidence of the utility of ultrasound-based elastography for cardiac hepatopathy remains insufficient [23,93,[103][104][105][131][132][133][134][135][136][137][138][139][140]. Because ultrasound-based elastography cannot differentiate blood from fibrosis, congestion influences the liver stiffness assessed by elastography.…”

Noteworthy Literature published in 2017 for Congenital Cardiac Anesthesiologists

“…At this time, Evans and colleagues studied a noninvasive composite Fontan hepatic index in 30 adult Fontan patients who underwent cardiac catheterization and liver biopsy. 60 They found that a composite index composed of hepatic ultrasound elastography measurements, MELD scores (Model for End Stage Liver Disease), and time post-Fontan strongly correlated with the total fibrosis score from liver biopsy.…”