Abstract 11981: Prognostic Value of Liver Stiffness Measurement in Patients Undergoing Left-Sided Valvular Surgery

Introduction: Hepatic fibrosis is a recognised extracardiac manifestation of advanced heart diseases. The assessment of cardiac hepatopathies with non-invasive tools such as FibroScan(®) has shown promising prognostic value in patients undergoing right-sided valvular surgery. While an increased level of liver stiffness has been observed in patients with left-sided heart failure (HF), the prognostic value of liver stiffness measurement (LSM) remains unknown in patients undergoing left-sided valvular surgeries. Methods: Pre-operative LSM were taken from 239 patients undergoing left-sided valvular surgery prospectively between February 2013 and March 2021 using FibroScan(®). Patients were followed up for adverse outcomes, including mortality or HF requiring hospitalisation. Clinical parameters were collected and patients’ EuroSCORE II were calculated. The prognostic value of LSM for mortality was determined by Cox proportional-hazards regression adjusted for EuroSCORE II; whereas the Fine-and-Gray method was used to assess the prognostic value for (HF) for taking mortality into account as a competing risk. Any incremental value to EuroSCORE II was assessed by continuous net reclassification (cNRI) and integrated discrimination improvement (IDI) indicies. Results: Over a median follow-up of 4.1 years, 20 patients died and 28 were hospitalized for HF. LSM was an independent predictor of mortality (hazard ratio [HR]=1.07, 95%CI 1.04-1.10) and provided incremental prognostic value when added to EuroSCORE II (cNRI=0.17, 95%CI 0.02-0.34; IDI=0.39, 95%CI 0.14-0.66). LSM was predictive of subsequent HF (subdistribution HR=1.04, 95% CI 1.01-1.06) whereas EuroSCORE II was not. Conclusion: Pre-operative LSM negatively affects long term outcomes in patients undergoing left-sided valvular surgery.