Strain elastography for detecting advanced Fontan-associated liver disease: a retrospective study

Area of Science:

• Hepatology
• Cardiology
• Medical Diagnostics

Background:

• The Fontan procedure improves single ventricle heart defect outcomes but can lead to Fontan-associated liver disease (FALD).
• Advanced FALD (aFALD) signifies portal hypertension and carries a poor prognosis.
• Noninvasive tests (NITs) show promise for assessing liver fibrosis in FALD, with limited evaluation of the SE-derived Liver Fibrosis Index (LFI).

Purpose of the Study:

• To evaluate the efficacy of NITs, particularly LFI, in discriminating aFALD.
• To assess the diagnostic performance of LFI compared to other noninvasive markers.

Main Methods:

• A retrospective study of 46 Japanese patients with FALD, categorized into aFALD and non-aFALD groups.
• Analysis of platelet count, FIB-4 index, Forns index, and LFI for diagnostic accuracy.
• Evaluation of Shear Wave Elastography (SWE) and its derived parameters.

Main Results:

• Platelet count, FIB-4, Forns index, and LFI significantly differed between aFALD and non-aFALD groups.
• A platelet count cut-off of 185 × 10^3/μL showed high specificity for aFALD.
• In patients with higher platelet counts, an LFI cut-off of 2.21 demonstrated 100% sensitivity for aFALD.

Conclusions:

• A two-step diagnostic strategy combining platelet count and LFI accurately identifies aFALD.
• Early detection and intervention for aFALD are crucial for improving patient outcomes.
• LFI shows potential as a valuable noninvasive tool for managing FALD.