Cardiac and Liver Fibrosis Assessed by Multiparametric MRI in Patients with Fontan Circulation

Area of Science:

• Cardiovascular Imaging
• Hepatology
• Biomedical Engineering

Background:

• Fontan circulation leads to abnormal hemodynamics, causing increased systemic venous pressure, hepatic venous congestion, and Fontan-associated liver disease.
• Combined assessment of cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI is not fully explored in this patient population.

Purpose of the Study:

• To evaluate cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI in patients who have undergone Fontan procedures.

Main Methods:

• Thirty-eight Fontan patients and 23 controls underwent cardiac and liver MRI examinations using a 3.0-T scanner.
• Statistical analyses included Mann-Whitney, Fisher exact test, and Spearman's correlation to assess myocardial volumes, function, native T1 mapping, extracellular volume (ECV), and liver stiffness.

Main Results:

• Fontan patients showed significantly higher native cardiac T1, cardiac ECV, liver native T1, liver ECV, and liver stiffness compared to controls (p < 0.05 for all).
• Indexed end-diastolic volume (EDVi) correlated with myocardial ECV, native liver T1, and liver stiffness (r = 0.356–0.571; p < 0.05).
• Liver stiffness correlated with liver ECV and native liver T1 (r = 0.361–0.458; p < 0.05), indicating an association between cardiac remodeling and cardiac/liver fibrosis.

Conclusions:

• Multiparametric MRI demonstrates an association between cardiac remodeling and cardiac and liver fibrosis in Fontan patients.
• MRI is critical for monitoring cardiac and liver involvement, potentially improving treatment strategies and preventing combined heart-liver transplantation.