Hepatic Portal Fibrosis but Not Central Fibrosis Is Associated with Elevated Right Atrial Pressure in Patients with Right Heart Failure
Dao-Fu Dai, Matthew M Yeh. University of Washington, Seattle, WA
Background: Chronic right heart failure predisposes to hepatic passive congestion and centrizonal necrosis, which may lead to hepatic fibrosis (cardiac sclerosis). While there have been several studies in the histologic features of hepatic passive congestion and fibrosis in individuals with right heart failure, the correlation of right heart physiology and the pattern of hepatic fibrosis remain unclear.
Design: Liver biopsies were examined in patients with right heart failure (n=36) of various etiologies including congenital heart disease, idiopathic cardiomyopathy, ischemic heart disease and valvular heart disease. The exclusion criteria were underlying chronic liver diseases, alcoholic liver disease, significant steatosis (> 10%), and malignant neoplasm. Right heart structure and function were examined by echocardiography and / or right heart catheterization. The pattern of fibrosis was correlated with echocardiographic parameters.
Results: The presence of portal fibrosis is associated with significantly higher right atrial pressure measured by echocardiography (see figure below), when compared with subjects with no fibrosis (p=0.029) or subjects with centrizonal fibrosis only (p=0.03).
The presence of portal fibrosis is also significantly associated with increasing severity of right atrial dilatation (p=0.02) and right ventricular dilatation (p=0.04), indicating long standing volume and / or pressure overload. Centrizonal fibrosis without portal fibrosis is significantly associated with right atrial dilatation (p=0.01), but not with right ventricular dilatation. Other histopathologic features include moderate to marked sinusoidal dilatation and centrizonal hepatocyte atrophy.
Conclusions: Although sinusoidal dilatation and centrizonal fibrosis are the hallmarks of hepatic passive congestion, the presence of portal fibrosis is suggestive of more advanced disease, as it correlates with more severe impairment of right heart function, regardless of the etiologies of right heart failure.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 109, Wednesday Afternoon