The prognostic role of liver volumetry in Fontan patients
The prognostic role of liver volumetry in Fontan patients
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DOI：
10.1017/s1047951122002992
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发表时间：
2022-10-19
影响因子：
1
通讯作者：
Veldtman, Gruschen R.
中科院分区：
文献类型：
--
作者：
Al Najashi, Khalid;Al Najashi, Nejoud;Veldtman, Gruschen R.
背景和假设：高静脉压和相关的肝脏充血是Fontan相关性肝病的重要驱动因素。然而，肝肿大作为充血标志的预后意义并未得到很好的定义，本研究进一步探讨了这一点。方法：从苏尔坦亲王心脏中心Fontan数据库中识别接受肝脏超声扫描的Fontan患者，并在机构伦理批准后从电子医疗记录中提取他们的解剖、手术和临床病史。肝脏体积是通过回顾单独的超声图像来回顾确定的，并根据(I)原发死亡或心脏或肝脏移植，或(Ii)死亡、移植、心律失常或蛋白缺失性肠病的继发联合终点的预定终点进行分析。结果：整个队列的平均指数肝体积为1065.1+/-312.1 ml/m(2)，范围为387-2071m l/m(2)。肝脏体积最大(最高三分位数)的患者与最低三分位数的患者相比，其功能性开窗的可能性较小，分别为44%和56%，p=0.016，并且经历了最高的死亡率和心脏或心脏-肝脏移植的负担，p=0.016，并且更有可能达到死亡、蛋白丢失性肠病、心律失常或移植的综合终点，p=0.010。肝脏体积对合并结果的总体预测准确率为61%(可信区间53%，67%，p=0.009)。结论：肝脏容量测定可能是Fontan手术后不良结局的一个潜在的重要充血生物标志物。
Background and hypotheses: High venous pressures and associated hepatic congestion are important drivers for Fontan-associated liver disease. The prognostic significance of hepatomegaly as a marker of congestion however is not well defined and is further explored in this research study. Methods: Fontan patients who have had liver ultrasound scans were identified from the Prince Sultan Cardiac Centre Fontan Database and had their anatomic, surgical, clinical histories abstracted from the electronic medical records following institutional ethics approval. Liver volumes were determined retrospectively from reviewing individual US images, and these, divided into tertiles, were analysed in the context of the predefined endpoints of (i) Primary - death or heart or liver transplantation, or (ii) Secondary - combined endpoint of death, transplantation, arrhythmia, or protein-losing enteropathy. Results: Mean indexed liver volumes for the entire cohort (n = 199) were 1065.1 +/- 312.1 ml/m(2), range 387 to 2071 ml/m(2). Patients with the largest liver volumes (highest tertile) were less likely to have a functioning fenestration compared to those in the lowest tertile 44% versus 56% p = 0.016 and experienced the highest burden of mortality and heart or heart-liver transplantation, p = 0.016, and were more likely to reach the composite endpoint of death, protein-losing enteropathy, arrhythmia, or transplantation, p = 0.010. Liver volumes had an overall predictive accuracy for the combined outcome of 61% (CI 53%, 67%, p = 0.009). Conclusions: Liver volumetry may serve as a potentially important congestion biomarker for adverse outcomes after the Fontan operation.