Clinical Scorecard: Impact of Cardiac Function on the Evaluation of MASLD via Indocyanine Green Clearance

At a Glance

Key Highlights

• ICG clearance is a noninvasive dynamic test measuring liver function via plasma disappearance rate (ICG-PDR) and retention rate (ICG-R15).
• Cardiac output significantly affects ICG clearance, suggesting the need to adjust ICG results for cardiac function to improve diagnostic accuracy.
• Histological severity of MASLD correlates with ICG clearance parameters, and adjusting for cardiac function may enhance this correlation.

Guideline-Based Recommendations

Diagnosis

• Use liver biopsy as the reference standard for MASLD diagnosis when feasible.
• Employ ICG clearance as a noninvasive test to assess liver function in MASLD patients.
• Consider cardiac output measurements to interpret ICG clearance results accurately.

Management

• Perform metabolic and bariatric surgery to treat obesity-related MASLD and improve liver histology.
• Exclude patients with iodine allergy, hyperthyroidism, or thyroid tumors before ICG administration.

Monitoring & Follow-up

• Measure ICG clearance preoperatively in fasting, supine patients to assess liver function.
• Monitor cardiac function concurrently with ICG clearance using noninvasive photoplethysmography devices.

Risks

• Liver biopsy carries risks and logistic challenges limiting its widespread use.
• ICG administration contraindicated in patients with iodine allergy or thyroid disorders.

Patient & Prescribing Data

Patients undergoing elective metabolic and bariatric surgery or elective cholecystectomy with BMI < 30

ICG administered intravenously at 0.25 mg/kg dose; cardiac function assessment improves interpretation of ICG clearance results.

Clinical Best Practices

• Perform ICG clearance measurements in fasting, supine patients to minimize systemic circulation variability.
• Use pulse dye densitometry with transcutaneous sensors for noninvasive ICG concentration measurement.
• Incorporate cardiac output and cardiac index measurements to adjust ICG clearance results for better correlation with liver histology.
• Exclude patients with contraindications to ICG such as iodine allergy or thyroid disease.
• Use standardized histological scoring (Kleiner score) for liver biopsy evaluation to classify MASLD severity.

References

• Kleiner et al. Histological scoring system for NAFLD
• ICG clearance in liver function assessment
• Cardiac output influence on ICG clearance