Reliability of transient elastography as a noninvasive method for estimating central venous pressure in adult patients after a Fontan procedure

Abstract

Background: In adult patients, after a Fontan procedure, high central venous pressure (CVP) is a hemodynamic risk factor associated with poor prognosis. High liver stiffness (LS) on transient elastography (TE) is associated with high CVP in patients with heart failure without liver disease. Here, we investigated whether LS assessment using TE is a reliable method to noninvasively evaluate CVP in adult patients after a Fontan procedure, who can present varying degrees of liver fibrosis as a complication. Methods: We measured LS using TE and CVP by cardiac catheterization in 24 adult patients who had undergone a Fontan procedure. The estimated CVP was calculated using the previously reported formula: −5.8 + 6.7 × ln[LS]. We examined the correlation between LS and CVP, and degree of agreement between the estimated and measured CVPs. Patients were divided into two groups, with or without suspected liver cirrhosis, based on abdominal imaging studies. Results: The median patient age was 35 years (interquartile range 25, 39). Overall, there was a strong correlation between LS and CVP (ρ = 0.83, p < 0.001). The estimated CVP based on LS and the CVP measured using cardiac catheterization were positively correlated; however, the estimated CVP tended to be higher than the measured CVP (mean difference 0.9 mmHg [95% limits of agreement: −2.8 to 4.6 mmHg]). These results were consistent across all groups. Conclusions: In adult patients after a Fontan procedure, LS measured by TE showed a positive correlation with CVP by cardiac catheterization. TE can be useful as a noninvasive estimation of CVP.

Keywords

• Adult
• Fontan procedure
• Central venous pressure
• Transient elastography
• Liver stiffness
• Liver cirrhosis