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

doi:10.1016/j.healun.2015.05.022

The Journal of Heart and Lung Transplantation

Volume 34, Issue 12, December 2015, Pages 1586-1594

https://doi.org/10.1016/j.healun.2015.05.022 Get rights and content

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.

Section snippets

Methods

This prospective study was performed in compliance with the Declaration of Helsinki and with approval from the local Ethics Committee. Written informed consent was obtained from all patients. The study evaluated 61 patients indicated for LVAD implantation due to chronic HF. Of those patients, 33 did not fulfil the inclusion criteria because an ARFI measurement was not feasible due to their severe illness or death before LVAD implantation. Thus, 28 patients were enrolled upon referral to the

Characteristics of the study cohort

The study enrolled 28 patients (23 male), who were a mean age of 54 ± 11 years. Overall, the mean LS measurement in the cohort using ARFI was increased (mean 2.50 ± 0.92 m/sec). Group II patients (n = 24) showed significantly higher baseline LS compared with Group I patients (p < 0.001). LS and baseline characteristics of the study cohort are described in Table 1. At baseline, ALT, AST, GLDH, ALP, platelets, and cholinesterase were in the normal range. Serum γ-GT, bilirubin, creatinine, HA, and

Discussion

This prospective study assessed LS measurement by ARFI elastography before and after LVAD implantation and illustrated the effect of end-stage chronic HF on LS in the presence of liver congestion secondary to pulmonary and systemic congestion. Importantly, using ARFI, we demonstrated that liver stiffness normalized in patients who underwent LVAD implantation as a bridging or permanent therapy.

The leading pathophysiology of hepatic dysfunction in end-stage chronic HF is not fully understood.¹

Disclosure statement

A.P. and M.G. have participated in studies on ARFI elastography and received lecture fees supported by Siemens Healthcare AG (Munich). None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose. A.S. contributed equally.

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¹: These authors have contributed equally to this work.

View full text

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

Background

Methods

Results

Conclusions

Section snippets

Methods

Characteristics of the study cohort

Discussion

Disclosure statement

J Heart Lung Transplant

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Hepatol

Hepatology

Clin Gastroenterol Hepatol

Eur J Radiol

Ultrasound Med Biol

J Hepatol

Is it difficult to obtain an optimal liver biopsy specimen?

Hepatology

Performance of transient elastography for the staging of liver fibrosis: a meta-analysis

Gastroenterology

Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis

J Viral Hepat

The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis

Eur Radiol

Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography

Radiology

Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation

Dig Dis Sci