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Noninvasive surrogates are poor predictors of liver fibrosis in patients with Fontan circulation

 Yu Rim Shin  ;  Seung Up Kim  ;  Sak Lee  ;  Jae Young Choi  ;  Han Ki Park  ;  Jeong Eun Yoo  ;  Young Nyun Park 
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.164(4) : 1176-1185.e3, 2022-10 
Journal Title
Issue Date
Adult ; Biomarkers ; Elasticity Imaging Techniques* / adverse effects ; Elasticity Imaging Techniques* / methods ; Fontan Procedure* / adverse effects ; Humans ; Liver / pathology ; Liver Cirrhosis / diagnosis ; Liver Cirrhosis / etiology ; Retrospective Studies
Fontan ; enhanced liver fibrosis ; hepatopathy ; liver fibrosis ; transient elastography
Objectives: Patients with Fontan circulation exhibit a high incidence of liver fibrosis and cirrhosis. Transient elastography (TE) and the enhanced liver fibrosis (ELF) test have proven useful as noninvasive surrogate markers of liver fibrosis for other chronic liver diseases. We evaluated whether TE and the ELF score can predict the degree of liver fibrosis in patients with Fontan circulation.

Methods: We retrospectively reviewed the medical records of 45 adult patients with at least 10 years of Fontan duration who had undergone liver biopsy and investigated the relation between the fibrosis stage and TE and the ELF test results. Additionally, the association of these variables and other biochemical and hemodynamic parameters was assessed.

Results: The mean age was 25.9 years and the mean Fontan duration was 20.8 years. Advanced liver fibrosis was present in 36 (80.0%) patients. TE or ELF score are comparable for patients with and without advanced liver fibrosis (mean 23.3 vs 24.8 kPa [P = .85] for TE; mean 8.94 vs 9.25 [P = .44] for the ELF score). However, N-terminal pro-brain natriuretic peptide level and ventricular end-diastolic pressure were higher in patients with advanced liver fibrosis (mean 224 vs 80 pg/mL [P < .01]; and mean 12 vs 9 mm Hg [P = .04], respectively). No independent predictor of advanced liver fibrosis was found in multivariate analysis.

Conclusions: TE and the ELF score were unable to predict the degree of liver fibrosis in Fontan patients. Liver biopsy remains as the only valid method to assess fibrotic burden in this population.
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Appears in Collections:
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Park, Han Ki(박한기) ORCID logo https://orcid.org/0000-0002-7472-7822
Shin, Yu Rim(신유림)
Yoo, Jeong Eun(유정은) ORCID logo https://orcid.org/0000-0001-9990-279X
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Choi, Jae Young(최재영) ORCID logo https://orcid.org/0000-0002-1247-6669
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