Evaluation of the relationship between estimated right atrial pressure and fibrosis-4 index in patients with congenital heart disease

Abstract

Objective: The fibrosis-4 index is a non-invasive and reproducible approach to assess liver stiffness (LS). LS has been reported to be associated with fibrosis but mean right atrial pressure can also influence LS values. We aimed to evaluate the relationship between fibrosis-4 index and echocardiographically estimated right atrial pressure in adults with congenital heart disease. Methods: This study was conducted at a tertiary heart center between January 2021 and January 2023. A total of 127 patients with congenital heart disease were included in the study. The fibrosis 4 index was calculated. The fibrosis-4 index was calculated as follows: Fibrosis-4 index = age (years) × AST (U/L)/[ALT (U/L)1/2 × platelet count (109/L)](14). Echocardiographic measurements were analyzed. The inferior vena diameter and collapsibility index were calculated and the estimated right atrial pressure was evaluated. Results: Study patients included 75 women (59%) with a mean age of 50 ± 9.9 years. Fibrosis-4 index was significantly correlated with TRV max (r = 0.51, p < 0.001), estimated right atrial pressure (r = 0.63, p < 0.001), estimated systolic pulmonary artery pressure (r = 0.42, p < 0.001), IVC diameter (r = 0.62, p < 0.001), IVC collapsibility (r = 0.464, p < 0.001), and NT-proBNp value (r = 0.624, p < 0.001). The fibrosis-4 index was also significantly correlated with the degree of tricuspid valve insufficiency(r = 0.342, p < 0.001), RV basal diameter (r = 0.294, p = 0.001), ASD diameter(r = 0.27, p = 0.002), Qp/Qs (r = 0.271, p = 0.003). However; the fibrosis 4 index was not significantly correlated with high-sensitive troponin (r = 0.11, p = 0.43). The fibrosis-4 index greater than 1.23 was associated with increased estimated right atrial pressure (IVC diameter > 21mm and IVC collapsibility < 50%), with a sensitivity of 95 % and a specificity of 74 % (AUC= 0.88; p