Liver stiffness measurements and short-term survival after left ventricular assist device implantation: A pilot study.

Abstract

BACKGROUND:

Hepatic dysfunction can contribute to the clinical outcome of patients with end-stage chronic heart failure (HF). This pilot study evaluated the importance of liver stiffness (LS) measurements by acoustic radiation force impulse (ARFI) imaging elastography in patients with end-stage chronic HF who underwent left ventricular assist device (LVAD) implantation.

METHODS:

The study enrolled 28 patients (23 men), mean age of 54 ± 11 years, with end-stage chronic HF selected for LVAD implantation. At baseline, all patients received LS measurements using ARFI elastography. Hepatic venous pressure gradient measurements and transjugular liver biopsies were performed in 16 patients. Liver stiffness was measured 21 days (Follow-up 1, n = 23) and 485 ± 136 days (Follow-up 2, n = 13) after LVAD implantation. Patients were classified according to their baseline LS into Group I (low baseline LS [no significant fibrosis = Metavir F < 2]) or Group II (high baseline LS [significant fibrosis = Metavir F ≥ 2]).

RESULTS:

LS at baseline was higher in Group II than in Group I (p < 0.001) and decreased significantly after LVAD implantation (Follow-up 1, p = 0.002; Follow-up 2, p = 0.002). Baseline LS correlated with liver fibrosis (p = 0.049) and central venous pressure (p = 0.001). Non-survivors showed higher LS (p = 0.019), bilirubin (p = 0.018), Model for End-Stage Liver Disease score (p = 0.001), and liver fibrosis (p = 0.004) compared with the survivors. In the univariate analysis, LS was a significant factor (p = 0.017) in predicting survival after LVAD implantation.

CONCLUSIONS:

ARFI elastography shows that LS is influenced by central venous congestion and histologic changes of the liver in patients with end-stage chronic HF. LS may predict the outcome in patients after LVAD implantation.

• Authors: Andrej Potthoff, Anika Schettler, Dina Attia, Jerome Schlue, Jan D Schmitto, Christine Fegbeutel, Martin Strüber, Axel Haverich, Michael P Manns, Heiner Wedemeyer, Michael Gebel, Andrea Schneider
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 34 Issue 12 Pg. 1586-94 (Dec 2015) ISSN: 1557-3117 [Electronic] United States
• PMID: 26169664 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Elasticity Imaging Techniques
• Female
• Heart Failure (complications, mortality, surgery)
• Heart-Assist Devices
• Humans
• Liver Cirrhosis (diagnostic imaging, etiology)
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Survival Rate
• Time Factors