Dynamics of the liver stiffness value using transient elastography during the perioperative period in patients with valvular heart disease.
TL;DR: LS can be overestimated in patients with VHD due to hepatic congestion, however, LS can be dynamically reversed during the perioperative period reflecting the restoration of cardiac function after a successful operation.
Abstract: Background/Aims
Liver congestion due to heart failure in patients with valvular heart disease (VHD) can result in an overestimate of the liver stiffness (LS) as assessed by transient elastography (TE). This prospective pilot study investigated the dynamics of LS during the perioperative valve operation period.
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TL;DR: Radiologists should be familiar with findings suggestive of CH at radiography, ultrasonography, computed tomography, MR imaging, and MR elastography to avoid diagnostic pitfalls and suggest appropriate additional diagnostic testing.
Abstract: Congestive hepatopathy (CH) refers to hepatic abnormalities that result from passive hepatic venous congestion. Prolonged exposure to elevated hepatic venous pressure may lead to liver fibrosis and cirrhosis. Liver dysfunction and corresponding clinical signs and symptoms typically manifest late in the disease process. Recognition of CH at imaging is critical because advanced liver fibrosis may develop before the condition is suspected clinically. Characteristic findings of CH on conventional images include dilatation of the inferior vena cava and hepatic veins; retrograde hepatic venous opacification during the early bolus phase of intravenous contrast material injection; and a predominantly peripheral heterogeneous pattern of hepatic enhancement due to stagnant blood flow. Extensive fibrosis can be seen in chronic or severe cases. Hyperenhancing regenerative nodules that may retain hepatobiliary contrast agents are often present. Magnetic resonance (MR) elastography can show elevated liver stiffness and may be useful in evaluation of fibrosis in CH because it can be incorporated easily into routine cardiac MR imaging. Preliminary experience with MR elastography suggests its future use in initial evaluation of patients suspected of having CH, for monitoring of disease, and for assessment after therapy. To facilitate appropriate workup and treatment, radiologists should be familiar with findings suggestive of CH at radiography, ultrasonography, computed tomography, MR imaging, and MR elastography. In addition, knowledge of underlying pathophysiology, comparative histologic abnormalities, and extrahepatic manifestations is useful to avoid diagnostic pitfalls and suggest appropriate additional diagnostic testing. (©)RSNA, 2016.
84 citations
TL;DR: The lack of effective clinical tools for predicting liver fibrosis and liver function suggests the need for the development of novel biomarkers in patients with CH to assist in the management of this complicated disease.
55 citations
Cites background from "Dynamics of the liver stiffness val..."
...026), suggesting improvement in congestion rather than reversal of fibrosis given the short time frame.(30) Only one small study (n = 10) exists comparing liver stiffness determined by TE to fibrosis stage by biopsy, and no studies exist for ARFI....
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TL;DR: The current literature on elastography-based prediction of “any” varices and VNT is summarized, and the published LSM and SSM cut-offs are summarized in clinically useful scale cards.
Abstract: Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM 150 G/L for ruling-out VNT in patients with cACLD. These (and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for "any" varices and for VNT. Finally, the measurement of spleen stiffness (SSM) by elastography (mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of "any" varices and VNT. Finally, we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.
51 citations
TL;DR: LS measurement using TE is a rapid and reliable method to evaluate CVP in patients with congenital heart disease and is significantly correlated with CVP.
Abstract: Objective Transient elastography (TE; Fibroscan, Echosens, France) is a non-invasive and reproducible approach to assess liver stiffness (LS). LS has been reported to be associated with fibrosis but central venous pressure (CVP) can also influence LS values. We sought to evaluate the correlation between LS and CVP in a large cohort of children and adults with congenital heart disease. Methods All patients referred in our institution between 2012 and 2013 for diagnostic or interventional right heart catheterisation (RHC) were prospectively enrolled excluding patients with acute heart failure, chronic alcohol abuse, chronic liver disease, severe obesity and ascites. Patients underwent LS measurement and CVP measurement by RHC under general anaesthesia within the same or subsequent day. Results Sixty children (7.4±5.5 years) and 36 adults (38±16 years) were included. Median CVP was 6 mm Hg (range 3–15), median LS was 5 kPa (range 2.8–47.2). LS significantly correlated with CVP (r=0.75, p −4 ). In the two subgroups (ie, children and adults), correlation was r=0.68 and r=0.84 (p −4 ), respectively. In the overall population, the area under the curve of LS for identification of CVP >10 mm Hg was 0.972 (95% CI 0.855 to 1; p 10 mm Hg was 8.8 kPa (sensitivity=91.67%, specificity=96.25%). Conclusions LS measurement using TE is a rapid and reliable method to evaluate CVP in patients with congenital heart disease.
50 citations
TL;DR: Increased LS measured by transient elastography reflects RAP elevation, hepatic congestion, and hepatic dysfunction, and LS upon admission may be a useful prognostic marker in patients with ADHF.
Abstract: BACKGROUND Acute decompensated heart failure (ADHF) is often accompanied by liver congestion through increased right atrial pressure (RAP). Liver stiffness (LS) assessed non-invasively using transient elastography is related to increased RAP and liver congestion in patients with general HF. We investigated the relationship of LS with clinical and echocardiographic variables and outcomes in patients with ADHF.Methods and Results:The subjects were 105 patients with ADHF admitted to hospital between October 2016 and June 2017. Patients were divided into 2 groups based on median LS at admission (low LS <8.8 kPa [n=52] vs. high LS ≥8.8 kPa [n=53]). Death from cardiovascular disease and readmission for HF were primary endpoints. Total bilirubin and γ-glutamyl transpeptidase levels, MELD-XI score, diameters of the inferior vena cava and right ventricle, and severity of tricuspid regurgitation were greater in the high LS group (all P<0.05). During a median (interquartile range) follow-up period of 153 (83-231) days, cardiac events occurred in 29 patients (54%) in the high LS group and in 13 (25%) in the low LS group (P=0.001). After adjusting for variables that influence organ congestion, a high LS ≥8.8 kPa was still significantly associated with cardiac events (all P<0.05). CONCLUSIONS Increased LS measured by transient elastography reflects RAP elevation, hepatic congestion, and hepatic dysfunction. LS upon admission may be a useful prognostic marker in patients with ADHF.
40 citations
References
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TL;DR: Liver elasticity measurements were reproducible, operator-independent and well correlated and the intra- and interoperator reproducibility of the technique, as well as its ability to quantify liver fibrosis, were evaluated in 106 patients with chronic hepatitis C.
Abstract: Chronic hepatitis is accompanied by progressive deposit of hepatic fibrosis, which may lead to cirrhosis. Evaluation of liver fibrosis is, thus, of great clinical interest and, up to now, has been assessed with liver biopsy. This work aims to evaluate a new noninvasive device to quantify liver fibrosis: the shear elasticity probe or fibroscan. This device is based on one-dimensional (1-D) transient elastography, a technique that uses both ultrasound (US) (5 MHz) and low-frequency (50 Hz) elastic waves, whose propagation velocity is directly related to elasticity. The intra- and interoperator reproducibility of the technique, as well as its ability to quantify liver fibrosis, were evaluated in 106 patients with chronic hepatitis C. Liver elasticity measurements were reproducible (standardized coefficient of variation: 3%), operator-independent and well correlated (partial correlation coefficient = 0.71, p /= F2) and with cirrhosis ( = F4), respectively. The Fibroscan is a noninvasive, painless, rapid and objective method to quantify liver fibrosis.
2,517 citations
"Dynamics of the liver stiffness val..." refers methods in this paper
...Immediately after a complete upper abdomen ultrasound examination, LS was measured according to a method reported previously [18]....
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TL;DR: Transient elastography can be performed with excellent diagnostic accuracy and independent of the underlying liver disease for the diagnosis of cirrhosis, however, for the diagnoses of significant fibrosis, a high variation of the AUROC was found that is dependent on the underlying Liver disease.
1,405 citations
"Dynamics of the liver stiffness val..." refers background or methods in this paper
...0 kPa are regarded as having an increased LS value compatible with liver cirrhosis or with increased hepatic congestion [4]....
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...After vigorous validation over the past several years [3,4], TE is now being used widely in clinical practice as an excellent tool for diagnosing cirrhosis when clinical data and physical examinations are indecisive....
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TL;DR: Transient elastography is a promising non-invasive method for detection of cirrhosis in patients with chronic liver disease and its use for the follow up and management of these patients could be of great interest and should be evaluated further.
Abstract: Background: Transient elastography (FibroScan) is a new, non-invasive, rapid, and reproducible method allowing evaluation of liver fibrosis by measurement of liver stiffness. In cirrhotic patients, liver stiffness measurements range from 12.5 to 75.5 kPa. However, the clinical relevance of these values is unknown. The aim of this prospective study was to evaluate the accuracy of liver stiffness measurement for the detection of cirrhosis in patients with chronic liver disease. Methods: A total of 711 patients with chronic liver disease were studied. Aetiologies of chronic liver diseases were hepatitis C virus or hepatitis B virus infection, alcohol, non-alcoholic steatohepatitis, other, or a combination of the above aetiologies. Liver fibrosis was evaluated according to the METAVIR score. Results: Stiffness was significantly correlated with fibrosis stage ( r = 0.73, p 2), 0.90 (0.86–0.93) for patients with severe fibrosis (F3), and 0.96 (0.94–0.98) for patients with cirrhosis. Using a cut off value of 17.6 kPa, patients with cirrhosis were detected with a positive predictive value and a negative predictive value (NPV) of 90%. Liver stiffness was significantly correlated with clinical, biological, and morphological parameters of liver disease. With an NPV >90%, the cut off values for the presence of oesophageal varices stage 2/3, cirrhosis Child-Pugh B or C, past history of ascites, hepatocellular carcinoma, and oesophageal bleeding were 27.5, 37.5, 49.1, 53.7, and 62.7 kPa, respectively. Conclusion: Transient elastography is a promising non-invasive method for detection of cirrhosis in patients with chronic liver disease. Its use for the follow up and management of these patients could be of great interest and should be evaluated further.
1,211 citations
"Dynamics of the liver stiffness val..." refers background in this paper
...The liver stiffness measurement using transient elastography (TE) is a rapid, noninvasive, and reproducible method of assessing liver fibrosis in patients with chronic liver diseases such as chronic hepatitis C, chronic hepatitis B, alcoholic liver disease, and primary biliary cirrhosis [1,2]....
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TL;DR: In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT- ProBNP in dysPNoeic patients.
Abstract: Aims Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents.
Methods and results Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P 75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2–8.1, P <0.001].
Conclusion In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.
998 citations
"Dynamics of the liver stiffness val..." refers background in this paper
...In all of these patients, NT-proBNP values on POD90 reached to level of , 300 pg/mL, which have a 98% negative predictive value for excluding acute HF [22]....
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University of Maryland Medical Center1, University of Chicago2, NewYork–Presbyterian Hospital3, Cleveland Clinic4, Beth Israel Deaconess Medical Center5, Wake Forest University6, Mayo Clinic7, Baylor College of Medicine8, University of California, San Francisco9, University of Wisconsin-Madison10, MedStar Washington Hospital Center11
916 citations
"Dynamics of the liver stiffness val..." refers methods in this paper
...Routine cardiologic parameters such as left ventricular ejection fraction (LVEF), left atrial volume (LAV), left atrial volume index (LAVI), left ventricle end systolic diameter (LVESD), left ventricle end diastolic diameter (LVEDD), and RVP were calculated according to the recommendations of the American Society of Echocardiography [15]....
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...Echocardiography was performed using a GE Vivid 7 ultrasound machine, and images were obtained from standard parasternal and apical views....
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