Impact of hepatic steatosis on outcomes after left ventricular assist device implantation.
adverse events
diabetes
hepatic steatosis
left ventricular assist device
obesity
survival
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
revised:
07
03
2021
received:
10
11
2020
accepted:
18
03
2021
pubmed:
31
3
2021
medline:
11
6
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
This single-center, retrospective study evaluates the impact of hepatic steatosis on outcomes after continuous-flow left ventricular assist device (LVAD) implantation. Adults undergoing LVAD implantation between 2004 and 2018 with a preoperative noncontrast-enhanced chest and abdominal computed tomography scan were included in the study. Patients were stratified as with and without radiographic signs of hepatic steatosis. The primary outcome was survival, and secondary outcomes included rates of postimplant adverse events. A total of 203 patients were included in the study. 27.6% (n = 56) had radiographic signs of hepatic steatosis. Hepatic steatosis group had a higher body mass index (30.1 vs. 27.0, p < .01), model for end-stage liver disease excluding international normalized ratio score (16.8 vs. 15.1, p = .05), and incidence of diabetes (53.6% vs. 35.4%, p = .02). The rates of postimplant adverse events, including bleeding, infection, reoperation, renal failure, hepatic dysfunction, stroke, and right ventricular failure, were similar between the groups (all, p > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, 1-year, and 2-year following LVAD implantation (all, p > .05). In addition, hepatic steatosis did not impact risk-adjusted overall mortality when modeled as a categorical variable (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.46-1.13; p = .15). This study demonstrates that the presence of preoperative hepatic steatosis on imaging is not predictive of increased morbidity or mortality following LVAD implantation. Despite the association with obesity, metabolic diseases, and heart failure, hepatic steatosis on imaging appears to have a limited role in patient selection or prognostication in LVAD patients.
Sections du résumé
BACKGROUND
BACKGROUND
This single-center, retrospective study evaluates the impact of hepatic steatosis on outcomes after continuous-flow left ventricular assist device (LVAD) implantation.
METHODS
METHODS
Adults undergoing LVAD implantation between 2004 and 2018 with a preoperative noncontrast-enhanced chest and abdominal computed tomography scan were included in the study. Patients were stratified as with and without radiographic signs of hepatic steatosis. The primary outcome was survival, and secondary outcomes included rates of postimplant adverse events.
RESULTS
RESULTS
A total of 203 patients were included in the study. 27.6% (n = 56) had radiographic signs of hepatic steatosis. Hepatic steatosis group had a higher body mass index (30.1 vs. 27.0, p < .01), model for end-stage liver disease excluding international normalized ratio score (16.8 vs. 15.1, p = .05), and incidence of diabetes (53.6% vs. 35.4%, p = .02). The rates of postimplant adverse events, including bleeding, infection, reoperation, renal failure, hepatic dysfunction, stroke, and right ventricular failure, were similar between the groups (all, p > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, 1-year, and 2-year following LVAD implantation (all, p > .05). In addition, hepatic steatosis did not impact risk-adjusted overall mortality when modeled as a categorical variable (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.46-1.13; p = .15).
CONCLUSIONS
CONCLUSIONS
This study demonstrates that the presence of preoperative hepatic steatosis on imaging is not predictive of increased morbidity or mortality following LVAD implantation. Despite the association with obesity, metabolic diseases, and heart failure, hepatic steatosis on imaging appears to have a limited role in patient selection or prognostication in LVAD patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2277-2283Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005-2023. https://doi.org/10.1002/hep.25762
VanWagner LB, Wilcox JE, Colangelo LA, et al. Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: a population-based study. Hepatology. 2015; 62(3):773-783. https://doi.org/10.1002/hep.27869
Zhang Z, Wang P, Guo F, et al. Chronic heart failure in patients with nonalcoholic fatty liver disease: prevalence, clinical features, and relevance. J Int Med Res. 2018; 46(9):3959-3969. https://doi.org/10.1177/0300060518782780
Fotbolcu H, Yakar T, Duman D, et al. Impairment of the left ventricular systolic and diastolic function in patients with non-alcoholic fatty liver disease. Cardiol J. 2010;17(5):457-463.
Karabay CY, Kocabay G, Kalayci A, et al. Impaired left ventricular mechanics in nonalcoholic fatty liver disease: a speckle-tracking echocardiography study. Eur J Gastroenterol Hepatol. 2014;26(3):325-331. https://doi.org/10.1097/MEG.0000000000000008
Pacifico L, Di Martino M, De Merulis A, et al. Left ventricular dysfunction in obese children and adolescents with nonalcoholic fatty liver disease. Hepatology. 2014; 59(2):461-470. https://doi.org/10.1002/hep.26610
Nassir F, Rector RS, Hammoud GM, Ibdah JA. Pathogenesis and prevention of hepatic steatosis. Gastroenterol Hepatol (N Y). 2015; 11(3):167-175.
Joy D, Thava VR, Scott BB. Diagnosis of fatty liver disease: is biopsy necessary? Eur J Gastroenterol Hepatol. 2003; 15(5):539-543. https://doi.org/10.1097/01.meg.0000059112.41030.2e
Limanond P, Raman SS, Lassman C, et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology. 2004; 230(1):276-280. https://doi.org/10.1148/radiol.2301021176
Hamer OW, Aguirre DA, Casola G, Sirlin CB. Imaging features of perivascular fatty infiltration of the liver: initial observations. Radiology. 2005;237(1):159-169. https://doi.org/10.1148/radiol.2371041580
Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006;26(6):1637-1653. https://doi.org/10.1148/rg.266065004
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018; 67(1):328-357. https://doi.org/10.1002/hep.29367
Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017; 36(10):1080-1086. https://doi.org/10.1016/j.healun.2017.07.005
STS INTERMACS. Users' Guide version 5.0. adverse event definitions. https://www.uab.edu/medicine/intermacs/images/Intermacs-Users-Guide-v5.0-2018-06-28.pdf. Accessed on September 21, 2020.
Fartoux L, Chazouillères O, Wendum D, Poupon R, Serfaty L. Impact of steatosis on progression of fibrosis in patients with mild hepatitis C. Hepatology. 2005; 41(1):82-87. https://doi.org/10.1002/hep.20519
Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524-530. https://doi.org/10.1016/j.cgh.2011.03.020
Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004; 40(6):1387-1395. https://doi.org/10.1002/hep.20466
Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274-285. https://doi.org/10.1111/j.1365-2036.2011.04724.x
Qayyum A, Nystrom M, Noworolski SM, Chu P, Mohanty A, Merriman R. MRI steatosis grading: development and initial validation of a color mapping system. AJR Am J Roentgenol. 2012;198(3):582-588. https://doi.org/10.2214/AJR.11.6729
Ndumele CE, Nasir K, Conceiçao RD, Carvalho JA, Blumenthal RS, Santos RD. Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation. Arterioscler Thromb Vasc Biol. 2011;31(8):1927-1932. https://doi.org/10.1161/ATVBAHA.111.228262
Patel N, Gluck JA, Radojevic J, Coleman CI, Baker WL. Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis. ESC Heart Fail. 2018;5(6):1141-1149. https://doi.org/10.1002/ehf2.12337
Musci M, Loforte A, Potapov EV, et al. Body mass index and outcome after ventricular assist device placement. Ann Thorac Surg. 2008;86(4):1236-1242. https://doi.org/10.1016/j.athoracsur.2008.05.044
John R, Aaronson KD, Pae WE, et al. Drive-line infections and sepsis in patients receiving the HVAD system as a left ventricular assist device. J Heart Lung Transplant. 2014;33(10):1066-1073. https://doi.org/10.1016/j.healun.2014.05.010
Boyle AJ, Jorde UP, HeartMate II Clinical Investigators, et al. Pre-operative risk factors of bleeding and stroke during left ventricular assist device support: an analysis of more than 900 HeartMate II outpatients. J Am Coll Cardiol. 2014;63(9):880-888. https://doi.org/10.1016/j.jacc.2013.08.1656
Kirklin JK, Naftel DC, Kormos RL, et al. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2014; 33(1):12-22.Erratum in: J Heart Lung Transplant. 2015 Oct;34(10):1356. Timothy Baldwin, J [corrected to Baldwin, J T]. https://doi.org/10.1016/j.healun.2013.11.001
Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores. Clin Gastroenterol Hepatol. 2004; 2(8):719-723. https://doi.org/10.1016/s1542-3565(04)00296-4
Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261-1269. https://doi.org/10.1053/j.gastro.2007.01.040
Yang JA, Kato TS, Shulman BP, et al. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 2012;31(6):601-610. https://doi.org/10.1016/j.healun.2012.02.027
Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation. 2010;121(2):214-220. https://doi.org/10.1161/CIRCULATIONAHA.108.838656
Critsinelis A, Kurihara C, Volkovicher N, et al. Model of end-stage liver disease-eXcluding international normalized ratio (MELD-XI) scoring system to predict outcomes in patients who undergo left ventricular assist device implantation. Ann Thorac Surg. 2018; 106(2):513-519. https://doi.org/10.1016/j.athoracsur.2018.02.082
Day CP, James OF. Steatohepatitis: a tale of two "hits"? Gastroenterology. 1998; 114(4):842-845. https://doi.org/10.1016/s0016-5085(98)70599-2