Key result
Preoperative liver stiffness >12.5 kPa was associated with an 80% incidence of major adverse events compared to 25% in patients with ≤12.5 kPa following LVAD implantation.
Why the study?
Does liver stiffness measured by transient elastography predict the requirement of RVAD and major adverse events in patients with severe heart failure undergoing LVAD implantation?
Observational (n=30)
No
Does liver stiffness measured by transient elastography predict the requirement of RVAD and major adverse events in patients with severe heart failure undergoing LVAD implantation?
Liver stiffness measured by transient elastography is a useful non-invasive marker that correlates with preoperative severity and predicts the need for right ventricular assist device support and postoperative complications in patients undergoing LVAD implantation.
Answers are grounded in this paper and cite their sources.
May support preoperative risk stratification before LVAD; leaves open whether elastography should guide RVAD decisions.
BACKGROUND: The aim of the present study was to assess the efficacy of a non-invasive method, transient elastography (FibroScan), in measuring liver stiffness (LS), and whether LS can be used as a marker of cardiac - and hence perioperative - status. METHODS AND RESULTS: Perioperative LS was prospectively measured using a FibroScan in 30 patients (21 male; 42.2 ± 13.3 years old) who underwent left ventricular assist device (LVAD) implantation. LS was checked pre- and postoperatively, then analyzed in regard to perioperative status. Preoperative LS was 13.3 ± 13.0 kPa (normal, <5.5 kPa), and was abnormal in 77% of patients. Four required bilateral VAD. LS in patients with bilateral VAD tended to be higher than in LVAD patients (25.1 ± 22.7 vs. 11.5 ± 10.5 kPa, P=0.051). No patient with LS ≤ 7.0 kPa required a right VAD. The incidence of major adverse events was lower in patients with LS ≤ 12.5 kPa (25% vs. 80%, P<0.05). There were also no mortalities among patients with LS ≤ 12.5 kPa. CONCLUSIONS: LS was correlated with preoperative severity in patients with severe heart failure and reflected liver congestion, and may be useful to predict the requirement of right VAD, as well as postoperative complications in patients with LVAD implantation. This novel modality may be a useful non-invasive assessment method for management of severe heart failure.
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Nishi et al. (2014) conducted an observational in Severe heart failure (n=30). Preoperative liver stiffness >12.5 kPa vs. Preoperative liver stiffness ≤12.5 kPa was evaluated on Major adverse events (MAE) within 30 days (p=<0.05). Preoperative liver stiffness >12.5 kPa was associated with an 80% incidence of major adverse events compared to 25% in patients with ≤12.5 kPa following LVAD implantation.
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