Non-invasive diagnostic imaging tests largely underdiagnose cardiac cirrhosis in patients undergoing advanced therapy
David Belzile1, Pierre Yves Turgeon1, Evelyne Leblanc2
1Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Canada.
Insights
Abdominal ultrasound, CT scans, and liver-spleen scintigraphy show limited accuracy in diagnosing cirrhosis in advanced heart failure patients. Liver biopsy remains crucial for assessing transplant or LVAD eligibility.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Patients with advanced heart failure are often ineligible for cardiac transplantation or left ventricular assist device (LVAD) implantation if they have liver cirrhosis.
- Accurate diagnosis of cirrhosis is critical for determining patient eligibility for these advanced therapies.
Purpose of the Study:
- To evaluate the diagnostic performance of abdominal ultrasound, CT scan, and liver-spleen scintigraphy in detecting cirrhosis among patients with advanced heart failure.
- To compare the accuracy of non-invasive imaging techniques against liver biopsy results.
Main Methods:
- A retrospective study involving 567 patients undergoing pre-transplantation or LVAD evaluation.
- Liver biopsy was performed on 54 patients to confirm or rule out cardiac cirrhosis.
- Results from abdominal ultrasound, CT scan, and liver-spleen scintigraphy were compared with histopathological findings.
Main Results:
- Histopathological evaluation identified cirrhosis in approximately 26% of patients who underwent liver biopsy.
- The sensitivity for detecting cirrhosis was 57% for ultrasound, 50% for CT scan, and 25% for scintigraphy.
- The specificity was 80% for ultrasound, 89% for CT scan, and 44% for scintigraphy.
Conclusions:
- Abdominal ultrasound demonstrated the highest combined sensitivity and specificity among the imaging modalities.
- Conventional imaging techniques may miss over a third of cirrhosis cases.
- Liver biopsy is recommended for high-risk patients to accurately assess cirrhosis and eligibility for heart transplantation or LVAD implantation.
Background:
Patients with liver cirrhosis are generally considered ineligible for isolated cardiac transplantation or left ventricular assist device (LVAD) implantation. The aim of this retrospective study is to explore the diagnostic value of abdominal ultrasound, computed tomography scan (CT scan) and liver-spleen scintigraphy to detect the presence of cirrhosis in patients with advanced heart failure.
Methods:
Among 567 consecutive patients who underwent pre-transplantation or LVAD evaluation, 54 had a liver biopsy to rule out cardiac cirrhosis; we compared the biopsy results with the imaging investigations.
Results:
In about 26% (n = 14) of patients undergoing liver biopsy, histopathological evaluation identified cirrhosis. The respective sensitivity of abdominal ultrasound, CT scan and liver-spleen scintigraphy to detect cirrhosis was 57% [29-82], 50% [16-84], and 25% [3-65]. The specificity was 80% [64-91], 89% [72-98], and 44% [20-70], respectively.
Conclusion:
Ultrasonography has the best-combined sensitivity and specificity for the diagnosis of cirrhosis. However, more than a third of patients with cirrhosis will go undiagnosed by conventional imaging. As liver biopsy is associated with a low rate of complication, it should be considered in patients with a high-risk of cirrhosis or with evidence of portal hypertension to assess their eligibility for heart transplantation or LVAD implantation.
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