Novel Method of Evaluating Liver Stiffness Using Transient Elastography to Evaluate Perioperative Status in Severe Heart Failure

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.