Josep Lluís Melero-Ferrer1, Ana Osa-Sáez2, Francisco Buendía-Fuentes3, Antonio Ballesta-Cuñat4, Lucía Flors5, María Rodríguez-Serrano2, Pilar Calvillo-Batllés4, Miguel-Ángel Arnau-Vives6, Miguel A Palencia-Pérez6, Joaquín Rueda-Soriano2. 1. Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España josep.melero@gmail.com. 2. Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Área Clínica del Corazón, Hospital Universitari i Politècnic La Fe, Valencia, España. 3. Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain. 4. Área Clínica de Imagen Médica, Hospital Universitari i Politècnic La Fe, Valencia, España. 5. Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA. 6. Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, España.
Abstract
OBJECTIVE: The development of liver fibrosis and cirrhosis due to long-standing liver congestion is known to occur in adult patients with Fontan circulation. Hepatic elastography has shown to be a useful tool for the noninvasive assessment and staging of liver fibrosis in chronic liver diseases, although the utility of this technique in Fontan patients remains to be adequately studied. METHODS: Twenty-one patients with Fontan circulation underwent an abdominal ultrasound and an acoustic radiation force impulse (ARFI) elastography. In order to compare the results from this group, a cohort of 14 healthy controls and another group containing 17 patients with cirrhosis were included. The association between the velocity values measured with elastography and clinical and analytical parameters were also studied. RESULTS: Mean shear waves propagation velocity in liver tissue in the Fontan group was 1.86 ± 0.5 m/s, with 76% of patients over the cirrhosis threshold (1.55 m/s). The control group had a mean velocity of 1.09 ± 0.06 m/s, while the cirrhotic group obtained 2.71 ± 0.51 m/s. Seven patients with Fontan circulation had increased liver enzymes. Liver ultrasound showed evidence of chronic liver disease in six patients. Velocity values obtained in the presence or absence of analytical or liver ultrasound abnormalities showed significant differences in the univariate analysis (P = .04 and P = .03 respectively). CONCLUSION: In conclusion, ARFI elastography showed increased wave propagation velocity values in the Fontan population suggesting increased liver stiffness which could be related to advanced fibrosis. A statistically significant association between ARFI values and the presence of analytical and ultrasound abnormalities has been demonstrated.
OBJECTIVE: The development of liver fibrosis and cirrhosis due to long-standing liver congestion is known to occur in adult patients with Fontan circulation. Hepatic elastography has shown to be a useful tool for the noninvasive assessment and staging of liver fibrosis in chronic liver diseases, although the utility of this technique in Fontan patients remains to be adequately studied. METHODS: Twenty-one patients with Fontan circulation underwent an abdominal ultrasound and an acoustic radiation force impulse (ARFI) elastography. In order to compare the results from this group, a cohort of 14 healthy controls and another group containing 17 patients with cirrhosis were included. The association between the velocity values measured with elastography and clinical and analytical parameters were also studied. RESULTS: Mean shear waves propagation velocity in liver tissue in the Fontan group was 1.86 ± 0.5 m/s, with 76% of patients over the cirrhosis threshold (1.55 m/s). The control group had a mean velocity of 1.09 ± 0.06 m/s, while the cirrhotic group obtained 2.71 ± 0.51 m/s. Seven patients with Fontan circulation had increased liver enzymes. Liver ultrasound showed evidence of chronic liver disease in six patients. Velocity values obtained in the presence or absence of analytical or liver ultrasound abnormalities showed significant differences in the univariate analysis (P = .04 and P = .03 respectively). CONCLUSION: In conclusion, ARFI elastography showed increased wave propagation velocity values in the Fontan population suggesting increased liver stiffness which could be related to advanced fibrosis. A statistically significant association between ARFI values and the presence of analytical and ultrasound abnormalities has been demonstrated.
Authors: Alexander Lemmer; Lisa VanWagner; Zaira Gasanova; Steve Helmke; Gregory T Everson; Daniel Ganger Journal: Congenit Heart Dis Date: 2019-08-01 Impact factor: 2.007
Authors: Charlotte de Lange; Marjolein J E Reichert; Joseph J Pagano; Mike Seed; Shi-Joon Yoo; Craig S Broberg; Christopher Z Lam; Lars Grosse-Wortmann Journal: J Cardiovasc Magn Reson Date: 2019-07-15 Impact factor: 5.364