Fontan Hepatopathy-Managing Unknowns.

Autor: Zentner D; Department of Medicine (RMH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: dominica.zentner@mh.org.au., Phan K; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia., Gorelik A; Department of Medicine (RMH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Cabrini Health Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic, Australia., Keung C; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Gastroenterology, Eastern Health, Melbourne, Vic, Australia., Grigg L; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia., Sood S; Department of Medicine (RMH), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Vic, Australia., Gibson R; Department of Radiology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medical Imaging, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia., Nicoll AJ; Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Gastroenterology, Eastern Health, Melbourne, Vic, Australia.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2023 Apr; Vol. 32 (4), pp. 535-543. Date of Electronic Publication: 2023 Jan 13.
DOI: 10.1016/j.hlc.2022.12.007
Abstrakt: Background and Aims: How to best monitor Fontan-associated liver disease (FALD) remains unclear. We describe results from a prospective liver care pathway in adults (n=84) with a Fontan circulation.
Methods: Routine assessment of the liver, by acoustic radiation force frequency and ultrasound was undertaken. Results, including liver biochemistry, systemic ventricular function (echocardiography), functional class, medication use and clinical endpoints (varices, hepatocellular carcinoma, heart transplantation and death) were collated.
Results: Most individuals returned a cirrhotic range acoustic radiation force impulse imaging (ARFI) result. ARFI values were greater in the proportion of individuals with hepatic nodularity (p=0.024). Univariate analysis demonstrated moderate correlation with platelet number (Spearmans rho= -0.376, p=0.049). Patients with clinical endpoints had lower platelets (p=0.012) but only a trend to hepatic nodularity (p=0.057). Clinical endpoints were more common in those with ventricular dysfunction (p=0.011). Multivariate analysis revealed that age at Fontan and being on angiotensin converting enzyme inhibitors (ACEI) predicted ARFI score (β=0.06 [95% CI 0.01-0.09], p=0.007 and β=0.53 [95% CI 0.17-0.89], p=0.005, respectively). However, these associations were not significant once adjusted for Fontan type, age at ARFI, systemic ventricle morphology, ventricle function, or Model for End-stage Liver Disease (MELD-XI) excluding international normalised ratio (INR) (p>0.05 for all).
Conclusions: Ideal FALD monitoring remains unclear. ARFI has utility as a binary non-invasive indicator of cirrhosis, highlighting individuals who may need more frequent ongoing monitoring for hepatocellular carcinoma. However, no definite advantage to serial ARFI, once cirrhotic range ARFI results are present, has been identified.
(Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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