Role of transient elastography in the diagnosis and prognosis of Fontan-associated liver disease  

作　　者：Marta Cuadros Marta Abadía Pilar Castillo María Dolores Martín-Arranz Nerea Gonzalo Miriam Romero Araceli García-Sánchez Javier García-Samaniego Antonio Olveira JoséRuiz-Cantador Óscar González-Fernández Inés Ponz Pablo Merás Carlos Merino Adriana Rodríguez-Chaverri Enrique Balbacid Consuelo Froilán 

机构地区：[1]Department of Gastroenterology and Hepatology,Hospital Universitario La Paz,Madrid 28046,Spain [2]Department of Cardiology,Hospital Universitario La Paz,Madrid 28046,Spain [3]Adult Congenital and Pediatric Heart Unit,Freeman Hospital,Newcastle Hospitals NHS Foundation Trust,Newcastle NE77DN,Newcastle upon Tyne,United Kingdom

出　　处：《World Journal of Gastroenterology》2025年第11期74-87,共14页世界胃肠病学杂志(英文)

摘　　要：BACKGROUND Fontan-associated liver disease(FALD)often occurs in patients with single-ventricle physiology following Fontan surgery,and ranges from liver congestion to cirrhosis.The assessment of the severity of FALD using noninvasive methods is challenging.However,transient elastography(TE)may be useful for the non-invasive evaluation of FALD and prediction of clinical outcomes.AIM To evaluate the role of TE in the diagnosis of FALD and its association with clinically relevant events.METHODS This retrospective single-center study(Hospital Universitario La Paz,Madrid),including 91 post-Fontan patients aged>18 years old.Laboratory and ultrasound findings,and liver stiffness measurements(LSM)by TE(FibroScan®)were assessed.FALD was defined using ultrasound criteria hepatomegaly,liver surface nodularity,parenchymal heterogeneity,hyperechoic lesions,spleno-RESULTS Patient characteristics were:60.4%male;Mean age,33.3±8.2 years;Mean elapsed time since surgery,24.3±7.7 years;89%with FALD;73%with advanced FALD.LSM by TE was associated with FALD[odds ratio(OR)=1.34;95%confidence interval(95%CI):1.10-1.64;P=0.003]and advanced FALD(OR=1.10;95%CI:1.01-1.19;P=0.023).Areas under the curve(AUC)were 0.905 and 0.764 for FALD and advanced FALD,respectively.FALD cut-off values comprised:Optimal,20 kPa(sensitivity:92.3%;specificity:80.0%);Rule-out,15 kPa(sensitivity:96.9%);Rule-in,25 kPa(specificity:100%).A FALD algorithm was proposed based on LSM by TE and elapsed time since surgery(AUC:0.877;sensitivity,95.4%;specificity,80.0%;positive predictive value,96.9%;negative predictive value,72.7%).LSM by TE was associated with clinically relevant events(OR=1.07;95%CI:1.01-1.13;P=0.021)and all-cause mortality(OR=1.23;95%CI:1.02-1.47;P=0.026).CONCLUSION In adult patients post-Fontan surgery,TE is a useful noninvasive method for FALD diagnosis.The association between LSM by TE and clinically relevant events suggests a role in prognosis.

关 键 词：Transient elastography Liver stiffness Fontan-associated liver disease FONTAN Congenital heart disease Single ventricle 

分 类 号：R57[医药卫生—消化系统]