Eur J Cardiothorac Surg. 2024 Jun 24:ezae249. doi: 10.1093/ejcts/ezae249. Online ahead of print.
ABSTRACT
OBJECTIVES: The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role for evaluation of liver disease in Fontan patients and explored possible diagnostic method for early detection of advanced liver fibrosis.
METHODS: Stable adult Fontan patients who could safely receive magnetic resonance examination were enrolled and blood biomarkers, transient elastography were also examined.
RESULTS: Forty-six patients received diffusion weighted imaging and 58.7% were with advanced liver fibrosis (severe liver fibrosis 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman’s ρ: -0.456, p = 0.001) and cholesterol levels (Spearman’s ρ: -0.383, p = 0.009), decreased with increasing severities of fibrosis. Using transient elastography, a cutoff value 14.2 kPa predicted presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and TE values as a composite, the prediction capability of advanced liver fibrosis was the most satisfactory (c statistic 0.817 ± 0.071, p < 0.001). A cutoff value of 5.0 revealed a sensitivity of 78% and a specificity of 82%.
CONCLUSIONS: In Fontan patients, diffusion-weighted imaging is helpful in detection of liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with calculated score > 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.
PMID:38913856 | DOI:10.1093/ejcts/ezae249
