Fontan Circulation in Adult Patients: Acoustic Radiation Force Impulse Elastography as a Useful Tool for Liver Assessment.

Autores de IIS La Fe

• Josep Lluís Melero Ferrer

  Autor

• Ana María Osa Sáez

  Autor

• Antonio Ballesta Cuñat

  Autor

• María Rodríguez Serrano

  Autor

• María Pilar Calvillo Batlles

  Autor

• Miguel Ángel Arnau Vives

  Autor

• Joaquín Rueda Soriano

  Autor

Participantes ajenos a IIS La Fe

• Buendia-Fuentes F
• Flors L
• Palencia-Perez MA

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

• Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

  

  Investigador Principal

  Pilar Medina Badenes

• Investigacion Biomédica en Imagen (GIBI 2-30)

  Investigador Principal

  Leonor Cerdá Alberich

Abstract

OBJECTIVE: The development of liver fibrosis and cirrhosis due to long-standing liver congestion is known to occur in adult patients with Fontan circulation. Hepatic elastography has shown to be a useful tool for the noninvasive assessment and staging of liver fibrosis in chronic liver diseases, although the utility of this technique in Fontan patients remains to be adequately studied. METHODS: Twenty-one patients with Fontan circulation underwent an abdominal ultrasound and an acoustic radiation force impulse (ARFI) elastography. In order to compare the results from this group, a cohort of 14 healthy controls and another group containing 17 patients with cirrhosis were included. The association between the velocity values measured with elastography and clinical and analytical parameters were also studied. RESULTS: Mean shear waves propagation velocity in liver tissue in the Fontan group was 1.86 +/- 0.5 m/s, with 76% of patients over the cirrhosis threshold (1.55 m/s). The control group had a mean velocity of 1.09 +/- 0.06 m/s, while the cirrhotic group obtained 2.71 +/- 0.51 m/s. Seven patients with Fontan circulation had increased liver enzymes. Liver ultrasound showed evidence of chronic liver disease in six patients. Velocity values obtained in the presence or absence of analytical or liver ultrasound abnormalities showed significant differences in the univariate analysis (P = .04 and P = .03 respectively). CONCLUSION: In conclusion, ARFI elastography showed increased wave propagation velocity values in the Fontan population suggesting increased liver stiffness which could be related to advanced fibrosis. A statistically significant association between ARFI values and the presence of analytical and ultrasound abnormalities has been demonstrated.

Keywords

• *ARFI; *Fontan circulation; *congenital heart disease; *congestive liver disease; *elastography; *liver cirrhosis; *liver fibrosis