title: Liver stiffness measurements and short-term survival after left ventricular assist device implantation: A pilot study.
abstract: BACKGROUND
  Hepatic dysfunction can contribute to the clinical outcome of patients with end-stage chronic heart failure (HF). This pilot study evaluated the importance of liver stiffness (LS) measurements by acoustic radiation force impulse (ARFI) imaging elastography in patients with end-stage chronic HF who underwent left ventricular assist device (LVAD) implantation.
  
  
  METHODS
  The study enrolled 28 patients (23 men), mean age of 54 ± 11 years, with end-stage chronic HF selected for LVAD implantation. At baseline, all patients received LS measurements using ARFI elastography. Hepatic venous pressure gradient measurements and transjugular liver biopsies were performed in 16 patients. Liver stiffness was measured 21 days (Follow-up 1, n = 23) and 485 ± 136 days (Follow-up 2, n = 13) after LVAD implantation. Patients were classified according to their baseline LS into Group I (low baseline LS [no significant fibrosis = Metavir F < 2]) or Group II (high baseline LS [significant fibrosis = Metavir F ≥ 2]).
  
  
  RESULTS
  LS at baseline was higher in Group II than in Group I (p < 0.001) and decreased significantly after LVAD implantation (Follow-up 1, p = 0.002; Follow-up 2, p = 0.002). Baseline LS correlated with liver fibrosis (p = 0.049) and central venous pressure (p = 0.001). Non-survivors showed higher LS (p = 0.019), bilirubin (p = 0.018), Model for End-Stage Liver Disease score (p = 0.001), and liver fibrosis (p = 0.004) compared with the survivors. In the univariate analysis, LS was a significant factor (p = 0.017) in predicting survival after LVAD implantation.
  
  
  CONCLUSIONS
  ARFI elastography shows that LS is influenced by central venous congestion and histologic changes of the liver in patients with end-stage chronic HF. LS may predict the outcome in patients after LVAD implantation.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology. Electronic address: potthoff.andrej@mh-hannover.de.
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology.
authors.forename: Anika
authors.initials: A
authors.lastname: Schettler
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology; Departement of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: Attia
authors.affiliation: Institute of Pathology.
authors.forename: Jerome
authors.initials: J
authors.lastname: Schlue
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Schmitto
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Fegbeutel
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Heart Center Leipzig, Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology.
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology.
authors.forename: Michael
authors.initials: M
authors.lastname: Gebel
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schneider
mesh_terms: D054459:Elasticity Imaging Techniques; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: ARFI; LVAD; acoustic radiation force impulse imaging; heart failure; left ventricular assist device; liver congestion; liver elastography; liver stiffness; ultrasound