Abstract 12745: Novel Evaluation of Liver Stiffness using Transient Elastography to Evaluate Perioperative Status in Severe Heart Failure Patients
OBJECTIVES: No useful non-invasive tools are available to appropriately evaluate the severity of heart failure. We focused on the impact of heart failure on the liver and hypothesized that liver stiffness (LS) measured by transient elastography (Fibroscan) reflects cardiac status. The efficacy of this non-invasive modality during perioperative management of severe heart failure patients was assessed.
METHODS: Perioperative liver stiffness was prospectively measured using a Fibroscan device in 20 patients (15 males, 39.6±13.5 years old) who underwent left ventricular assist device (LVAD) implantation. None had a history of hepatitis. LS was checked preoperatively and on postoperative day 3, 7, and 28, then analyzed with preoperative status, operative results, and postoperative status.
RESULTS: (1) Preoperative LS was 15.1±14.0 kPa (normal ≤4 kPa) and 85% of the patients had elevated LS. (2) Sixteen had LVAD and 4 required bilateral VAD. Of those with LVAD, 5 required a tricuspid annuloplasty (TAP) due to difficulty with cardiopulmonary bypass weaning. LS in patients with bilateral VAD tended to be higher than that in LVAD patients (25.1±22.1 vs. 10.8±9.8 kPa, p=0.058). No patient with LS ≤7.5 kPa required right VAD or TAP, while those were performed in 9 of 10 (90%) with LS ≥7.5 kPa. (3) LS changed during the postoperative period and was correlated to central venous pressure. In patients with LS ≤7.5 kPa, LS reached maximum on day 3 and remained elevated on day 7, before returning to normal (Figure). (4) The incidence of major adverse cardiac events was lower in patients with LS ≤7.5 kPa (80% vs. 30%, p≤0.05).
CONCLUSIONS: LS was correlated with preoperative severity in patients with severe heart failure, and useful to predict the requirement of right VAD or postoperative complications in patients with LVAD implantation, while its change reflected liver congestion. This new modality may be a useful non-invasive assessment for management of severe heart failure.
- © 2013 by American Heart Association, Inc.