The Fontan Heart’s Silent Partner: Liver Fibrosis as a Harbinger of Mortality
For adults living with the long-term consequences of the Fontan procedure—a palliative surgery for complex congenital heart disease—liver complications are a major concern. This retrospective study of 334 patients found that non-invasive biomarkers of liver fibrosis, including the FibroSURE score, APRI, FIB-4, and MELD-XI, were strongly associated with an increased risk of death or heart transplant. The hazard was particularly pronounced; for example, a FibroSURE score above 0.74 was linked to a more than fivefold increased risk. The findings suggest that routine monitoring of these readily available liver fibrosis scores could provide critical prognostic information for risk-stratifying this vulnerable patient population.
Why it might matter to you:
This work underscores the systemic nature of advanced heart failure, where extra-cardiac organ dysfunction, driven by chronic inflammation and congestion, becomes a key determinant of outcome. It highlights a practical, biomarker-based strategy for risk stratification that complements advanced imaging. For your focus on translational pathways and precision phenotyping, it reinforces the need to integrate hepatic health into the comprehensive assessment of patients with complex inflammatory cardiomyopathies and right heart failure.
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