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Title: Hepatic effects of right heart lesions in adult congenital heart disease : observational study of novel measures of hepatic stiffness in right heart valvular regurgitation
Author: Abraham, Dilip
ISNI:       0000 0004 7973 2131
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2018
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Background: The optimum timing of pulmonary valve replacement for pulmonary regurgitation in adults (following repair of Tetralogy of Fallot or Pulmonary Stenosis) is under constant refinement. Right ventricular failure causes hepatic congestion which may lead to hepatic fibrosis. Non-invasive methods of measuring hepatic stiffness, a surrogate for hepatic fibrosis, have been developed. The main study aims were to determine if subclinical abnormalities of hepatic structure were present within this population, and whether this correlated with established prognostic markers including right ventricular ejection fraction. Methodology: This observational cross-sectional study examined markers of hepatic stiffness using three modalities, including two imaging modalities - Fibroscan and Magnetic Resonance Elastography (MRE), and one serum test - the Enhanced Liver Fibrosis panel (ELF score). Cardiovascular magnetic resonance imaging, electrocardiography, cardiopulmonary exercise test, and NT-Pro-BNP were also utilised. Participants were divided into three study groups. Group 1 contained participants with Moderate-Severe Pulmonary Regurgitation, Group 2 Mild Pulmonary Regurgitation, and Group 3 Tricuspid Regurgitation related to Ebstein's Anomaly (comparator group). Results: ANOVA testing detected no significant difference between study groups across all three indices of hepatic stiffness. Univariate linear regression was performed using the hepatic primary outcomes as the dependent variable in participants with pulmonary regurgitation (Groups 1&2). ELF score significantly correlated (Pearson's correlation coefficient 'r') with right ventricular ejection fraction (r = -0.37, p = 0.03), QRS duration (r = 0.51, p = 0.002), and NT-Pro-BNP (r = 0.39, p = 0.02). MRE significantly correlated with right ventricular end diastolic volume (r = 0.42, p = 0.01), QRS duration (r = 0.043, p = 0.017), and NT-Pro-BNP (r = 0.48, p = 0.006). Fibroscan significantly correlated with NT-Pro-BNP (r = 0.46, p = 0.01). Conclusion: Measurements of hepatic stiffness correlate significantly with established prognostic markers, and may be useful in the clinical surveillance of patients with pulmonary regurgitation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available