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Shibata N, Ito T, Toyoda H, Tanaka A, Morita Y, Kanzaki Y, Watanabe N, Yoshioka N, Yasuda S, Morishima I. Predictability of noninvasive liver fibrosis score for cardiac events in patients with nonalcoholic fatty liver disease. Nutr Metab Cardiovasc Dis 2024; 34:2115-2123. [PMID: 38664121 DOI: 10.1016/j.numecd.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/23/2024] [Accepted: 03/20/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND AIMS Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of cardiac events. However, although the severity of liver fibrosis is related to worsening prognosis in patients with NAFLD, it is unclear whether the noninvasive liver fibrosis score has a predictive value for cardiac events. METHODS AND RESULTS We evaluated 4071 patients with NAFLD diagnosed using ultrasonography. Liver fibrosis was assessed and divided into three groups based on the Fibrosis-4 (FIB4) index and NAFLD fibrosis score (NFS). The primary outcome of this study was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. The median age of the evaluated patients was 61 (52-69) years, and 2201 (54.1%) were male. During the median follow-up period of 6.6 years, 179 (4.4%) patients experienced MACE. Kaplan-Meier survival analysis demonstrated that MACE increased progressively with the FIB4 index (log-rank, p < 0.001) and NFS (log-rank, p < 0.001). Multivariable analysis showed that the higher the FIB4 index, the higher the risk for MACE (low group as reference vs. intermediate group, hazard ratio [HR]: 1.860 [95% confidence interval (CI), 1.326-2.610; p < 0.001]; vs. high group, HR:3.325 [95% CI, 2.017-5.479; p < 0.001]), as well as NFS (low NFS group as reference vs. intermediate group, HR: 1.938 [95% CI, 1.391-2.699; p < 0.001]; vs. high group, HR: 3.492 [95% CI, 1.997-6.105; p < 0.001]). CONCLUSIONS The FIB4 index and NFS are associated with the probability of MACE in patients with NAFLD. CLINICAL TRIALS The study design was approved by the ethics review board of Ogaki Municipal Hospital (approval number: 20221124-12, registration date: November 28th, 2022). https://www.ogaki-mh.jp/chiken/kenkyu.html.
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Affiliation(s)
- Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
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Das DS, Anupam A, Saharia GK. Association between liver fibrosis scores and short-term clinical outcomes in hospitalized chronic kidney disease patients: a prospective observational study. Front Med (Lausanne) 2024; 11:1387472. [PMID: 39228803 PMCID: PMC11368745 DOI: 10.3389/fmed.2024.1387472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction In resource-constrained countries, inadequate access to healthcare and prognostic tools can be the Achilles' heel in effectively managing chronic kidney disease (CKD). There is a significant similarity in the pathogenesis of CKD and liver fibrosis. The role of liver fibrosis (LF) scores in predicting short-term clinical outcomes in hospitalized patients with CKD is unknown. Our study aimed at calculating LF scores and studying the association of liver fibrosis with short-term mortality and morbidity in CKD patients. Methods Patients aged above 15 years diagnosed with CKD as per the KDIGO criteria were enrolled. LF scores, namely, NFS, GPRI, and FIB-4 scores were calculated. Patients were followed up for a period of 28 days for good and poor composite outcomes, namely, the requirement of hemodialysis, non-invasive ventilation, prolonged hospital stay, and neurological and cardiovascular outcomes including death. Results Among 163 patients, 70.5% were below 60 years of age, 82.2% were male and 35% were diabetic. At 28-day follow up, 52.1% had poor composite outcome. The AUROC for GPRI and FIB-4 in predicting poor outcomes was 0.783 (95% CI: 0.71-0.855) (p < 0.001) and 0.62 (95% CI: 0.534-0.706) (p = 0.008), respectively. The AUROC for GPRI and NFS in predicting all-cause mortality was 0.735 (95% CI: 0.627-0.843) (p = 0.001) and 0.876 (95% CI, 0.8-0.952) (p < 0.001), respectively. Conclusion We found a positive association between LF scores and CKD outcomes in hospitalized patients. The LF scores significantly predicted poor outcomes in patients with CKD. Among the scores, GPRI was found to be a stronger predictor in predicting outcomes in both diabetic and non-diabetic patients with CKD. A high GPRI score was also associated with poor outcomes and increased mortality in both diabetics and non-diabetics.
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Affiliation(s)
- Dhriti Sundar Das
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Anurag Anupam
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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He HM, Zheng SW, Chen YN, Zhu LY, Wang Z, Jiao SQ, Yang FR, Sun YH. A Comparison of the Prognostic Value of Liver Fibrosis Scores in Acute Myocardial Infarction Patients With and Without Type 2 Diabetes. Angiology 2024; 75:219-230. [PMID: 37658802 DOI: 10.1177/00033197231197230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Liver fibrosis scores have been demonstrated to be associated with poor prognosis after percutaneous coronary intervention (PCI). However, no studies have compared the prognostic value of these scores in acute myocardial infarction (AMI) patients with and without diabetes. We retrospectively enrolled 1576 AMI patients who underwent PCI. There were 177 all-cause deaths and 111 cardiac deaths during follow-up (median 3.8 years). The non-alcoholic fatty liver disease fibrosis score (NFS) showed a better prognostic value than the fibrosis-8 (FIB-8) score (Harrell's C-index: 0.703 vs 0.671, P = .014) and the fibrosis-4 (FIB-4) score (Harrell's C-index: 0.703 vs 0.648, P < .001) in the overall population. In the time-dependent receiver operating characteristic analysis, the NFS also had the highest area under the curve across all time points. Consistent results were observed in diabetic and non-diabetic populations. Adding the NFS to traditional cardiovascular risk factors significantly improved the prediction both for all-cause mortality (Harrell's C-index: 0.806 vs 0.771, P < .001) and cardiac death (Harrell's C-index: 0.800 vs 0.771, P = .014). The NFS showed a better prognostic value than the FIB-8 score and the FIB-4 score in patients with AMI undergoing PCI, which might be preferable for estimating the risk of mortality regardless of the presence or absence of diabetes.
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Affiliation(s)
- Hao-Ming He
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shu-Wen Zheng
- Department of Cardiology, Beijing University of Chinese Medicine School of Traditional Chinese Medicine, Beijing, China
| | - Yi-Nong Chen
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Long-Yang Zhu
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Zhe Wang
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Si-Qi Jiao
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Fu-Rong Yang
- Department of Cardiology, Beijing University of Chinese Medicine School of Traditional Chinese Medicine, Beijing, China
| | - Yi-Hong Sun
- Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiology, Beijing University of Chinese Medicine School of Traditional Chinese Medicine, Beijing, China
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
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Colak E, Acar B, Cakir O, Celikyurt U, Baris O, Torun A, Tosun ME, Agir A, Sahin T, Ciftci E. Evaluation of the non-alcoholic fatty liver fibrosis score in predicting short-term outcomes and severe coronary artery disease in patients undergoing coronary computed tomography angiography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:45-52. [PMID: 38616939 PMCID: PMC11008510 DOI: 10.5114/aic.2024.136405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/02/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction The correlation between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease is well established. Aim The objective of this study was to assess the short-term associations of the non-alcoholic fatty liver disease fibrosis score (NFS) with various outcomes, including mortality, severe coronary artery disease, myocardial infarction, and the need for coronary angiography, among patients who underwent coronary computed tomographic angiography (CCTA). Material and methods In this study, we assessed 499 patients who underwent 640-slice CCTA and evaluated their liver fibrosis using the NFS. The NFS takes into account factors such as age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase/alanine aminotransferase ratio, platelets, and albumin. Our primary focus was myocardial infarction, the need for coronary angiography, and death. Additionally, we examined the association between NFS and severe coronary artery disease. Results Patients with a higher NFS had a greater number of coronary angiography procedures and higher Agatston score (p < 0.001), with NFS and Agatston score emerging as independent predictors of severe coronary artery disease and the primary endpoint. An NFS value above -0.92 could predict the primary endpoint with 61% sensitivity and 63% specificity, while an NFS value above -0.88 could predict severe coronary artery disease with 62% sensitivity and 65% specificity. To analyze primary endpoints, the Kaplan-Meier method was used for survival analysis, with NFS groups compared using the log-rank test. During the follow-up period, patients with higher NFS were exposed to primary outcomes at an earlier period (p = 0.009). Conclusions NFS is an effective predictor of major cardiovascular events such as death, myocardial infarction, severe coronary artery disease, and the need for coronary angiography. These findings underscore the importance of NFS as a valuable tool for risk assessment and early intervention in patients with suspected or confirmed coronary artery disease.
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Affiliation(s)
- Esra Colak
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Burak Acar
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Baris
- Department of Cardiovascular Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Akın Torun
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Eren Tosun
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aysen Agir
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Tayfun Sahin
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ercument Ciftci
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Muzurović E, Maćešić M, Kavarić S. Liver Fibrosis and Atherosclerosis, a Consequence of Metabolic Dysfunction-Do They Share a Similar Pathophysiological Background? Angiology 2024:33197241234076. [PMID: 38358750 DOI: 10.1177/00033197241234076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Marija Maćešić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sreten Kavarić
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
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Chimoriya R, Ho V, Wang ZV, Chang R, Boumelhem BB, Simmons D, Kormas N, Gorrell MD, Piya MK. Application and Diagnostic Performance of Two-Dimensional Shear Wave Elastography and Liver Fibrosis Scores in Adults with Class 3 Obesity. Nutrients 2023; 16:74. [PMID: 38201904 PMCID: PMC10780854 DOI: 10.3390/nu16010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
There are no ideal non-invasive tests for assessing the severity of liver fibrosis in people with metabolic dysfunction-associated steatotic liver disease (MASLD) and class 3 obesity, where body habitus often makes imaging technically challenging. This study aimed to assess the applicability and diagnostic performance of two-dimensional shear wave elastography (2D-SWE), alongside several serum-based liver fibrosis scoring methods, in individuals with class 3 obesity. A cross-sectional study was conducted in patients aged ≥18 years and with a body mass index (BMI) ≥ 40 kg/m2 who were participants in a publicly funded multidisciplinary weight management program in South Western Sydney. The 2D-SWE was performed using the ElastQ Imaging (EQI) procedure with the Phillips EPIQ Elite series ultrasound. An EQI Median value of ≥6.43 kPa was taken as a cutoff score for significant fibrosis, and the scan was considered valid when the liver EQI IQR/Med value was <30%. The Fibrosis-4 (FIB-4) index, AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and circulating fibroblast activation protein index (FAP index) were calculated from fasting blood samples. The participants (n = 116; 67.2% female) were aged 47.2 ± 12.9 years, with BMI 54.5 ± 11.0 kg/m2. EQI Median values were obtained for 97.4% (113/116) of the 2D-SWE scans, and 91.4% (106/116) of the scans were considered valid. The EQI Median values exhibited a moderately positive correlation with the FIB-4 index (r = 0.438; p < 0.001) and a weakly positive correlation with the APRI (r = 0.388; p < 0.001), NFS (r = 0.210; p = 0.036) and FAP index (r = 0.226; p = 0.020). All liver fibrosis scores were positively correlated with one another. Among those referred for a liver biopsy based on the 2D-SWE and serum scores, half (11/22) underwent liver biopsy, and their 2D-SWE scores exhibited 72.7% accuracy (sensitivity: 71.4%; specificity: 75%) in detecting significant fibrosis. Our results show that 2D-SWE is a feasible, non-invasive test to assess liver fibrosis among people with class 3 obesity. Further research is needed to assess how 2D-SWE can be used alongside existing serum-based risk scores to reliably detect significant fibrosis, which would potentially reduce the need for invasive liver biopsy.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
| | - Vincent Ho
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Ziqi Vincent Wang
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - Ruby Chang
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Badwi B. Boumelhem
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Nic Kormas
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
| | - Mark D. Gorrell
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (Z.V.W.); (B.B.B.); (M.D.G.)
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (R.C.); (V.H.); (D.S.)
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia; (R.C.); (N.K.)
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Jain V, Mehta A, Lee TB, Liu C, Chew NWS, Ko Y, Gold ME, Gold DA, Vatsa N, Desai SR, Kim JH, Rahbar A, Haroun Y, Ejaz K, Hayek SS, Siddiqui MS, Salloum FN, Sperling LS, Sanyal AJ, Quyyumi AA. Immune Activation Mediates the Association of Advanced Hepatic Fibrosis With Adverse Outcomes in Patients With Coronary Artery Disease. J Am Heart Assoc 2023; 12:e031230. [PMID: 38063161 PMCID: PMC10863787 DOI: 10.1161/jaha.123.031230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Literature suggests a bidirectional association between advanced hepatic fibrosis (AHF) and coronary artery disease (CAD). We evaluated the association of AHF with immune activation, systemic inflammation, and adverse outcomes in patients with CAD. METHODS AND RESULTS A fibrosis-4 index cutoff value ≥2.67 was used to define AHF. Circulating levels of soluble urokinase plasminogen activator receptor and hsCRP (high-sensitivity C-reactive protein) were measured as markers for immune activation and systemic inflammation, respectively. The relationship of AHF with soluble urokinase plasminogen activator receptor, hsCRP, and adverse cardiovascular outcomes was evaluated. Among 3406 participants with CAD, 479 had AHF. Participants with AHF were older; were less likely to be Black individuals; and had a lower body mass index, worse renal function, and a prior history of heart failure. In multivariable linear regression models adjusted for clinical and demographic confounders, participants with AHF had 15.6% higher soluble urokinase plasminogen activator receptor and 24.0% higher hsCRP levels. They were more likely to experience the following adverse outcomes: all-cause death (adjusted hazard ratio [HR], 1.57 ([95% CI, 1.29-1.92]; P<0.001) and cardiovascular death: (subdistribution HR, 1.50 [95% CI, 1.14-1.95]; P=0.003). Mediation analysis showed that 47.0% (95% CI, 13.6%-81.2%]; P=0.006) of the indirect effect of AHF on cardiovascular death was mediated by circulating soluble urokinase plasminogen activator receptor levels. CONCLUSIONS AHF is independently associated with immune activation, systemic inflammation, and adverse cardiovascular outcomes in patients with CAD. The association of AHF with adverse outcomes is partly mediated by immune activation, and targeting this pathway may help reduce the residual risk in patients with CAD.
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Affiliation(s)
- Vardhmaan Jain
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Anurag Mehta
- Virginia Commonwealth University Health Pauley Heart CenterRichmondVAUSA
| | - Terence B. Lee
- Virginia Commonwealth University Health Pauley Heart CenterRichmondVAUSA
| | - Chang Liu
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Nicholas W. S. Chew
- Department of CardiologyNational University Heart Centre, National University Health SystemSingapore
| | - Yi‐An Ko
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Matthew E. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Daniel A. Gold
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Nishant Vatsa
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Shivang R. Desai
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Jonathan H. Kim
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Alireza Rahbar
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Yazan Haroun
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Kiran Ejaz
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Salim S. Hayek
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMIUSA
| | | | - Fadi N. Salloum
- Virginia Commonwealth University Health Pauley Heart CenterRichmondVAUSA
| | - Laurence S. Sperling
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
| | - Arun J. Sanyal
- Virginia Commonwealth University Stravitz‐Sanyal Liver InstituteRichmondVAUSA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of MedicineEmory Clinical Cardiovascular Research Institute, Emory University School of MedicineAtlantaGAUSA
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Shi SY, Jia F, Wang MF, Zhou YF, Li JJ. Impacts of Non-alcoholic Fatty Liver Disease on Acute Coronary Syndrome: Evidence and Controversies. Curr Atheroscler Rep 2023; 25:751-768. [PMID: 37768409 PMCID: PMC10564833 DOI: 10.1007/s11883-023-01146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Acute coronary syndrome (ACS) and non-alcoholic fatty liver disease (NAFLD) are two clinically common disease entities that share numerous risk factors. This review aimed to discuss the impacts of NAFLD on ACS. RECENT FINDINGS In an era of improved control of traditional risk factors, the substantial burden of cardiometabolic abnormalities has caused widespread concern. NAFLD is considered the hepatic component of metabolic syndrome, which can exert an impact on human health beyond the liver. Accumulating studies have demonstrated that NAFLD is closely related to cardiovascular disease, especially coronary artery disease. Interestingly, although recent data have suggested an association between NAFLD and the incidence and outcomes of ACS, the results are not consistent. In this review, we comprehensively summarized evidence and controversies regarding whether NAFLD is a contributor to either the development of ACS or worse outcomes in patients with ACS. The potential pathophysiological and molecular mechanisms involved in the impacts of NAFLD on ACS were also elucidated.
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Affiliation(s)
- Shun-Yi Shi
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fang Jia
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Meng-Fei Wang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya-Feng Zhou
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou, China
| | - Jian-Jun Li
- Cardio-Metabolism Center, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 10037, China.
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Lu C, Chen Y, Zhang Y, Zhao X. Liver Fibrosis Scores and Coronary Artery Disease: Novel Findings in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease. Diabetes Metab Syndr Obes 2023; 16:2627-2637. [PMID: 37663203 PMCID: PMC10474841 DOI: 10.2147/dmso.s426102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed term as a more appropriate definition for nonalcoholic fatty liver disease (NAFLD). Previous studies have shown an association between liver fibrosis scores and cardiovascular disease (CVD) in patients with NAFLD. In this study, we aimed to investigate the relationship between liver fibrosis scores and coronary artery disease (CAD) severity in patients with MAFLD. Methods This study was conducted on 1346 patients with MAFLD at the Second Hospital of Dalian Medical University between January 2018 and December 2021. We calculated the liver fibrosis scores, including the fibrosis 4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase-to-platelet ratio index (APRI). We divided the participants into three groups based on the degree of coronary artery stenosis assessed using coronary computed tomography angiography (CCTA): CAD (≥50%), non-obstructive (1-49%), and normal (no stenosis). Results An increased FIB-4 score and NFS were significantly associated with CAD severity in patients with MAFLD. The percentage of patients with a high FIB-4 score was higher in the CAD group than in the other two groups (5.80%, 4.31%, and 2.24%, respectively; p<0.001), as was the percentage of patients with NFS (11.12%, 5.19%, and 0.93%, respectively; p<0.001). Carotid atherosclerosis, creatinine levels, and CAC scores were significant predictors of CAD. The FIB-4 score and NFS were independently associated with CAD even after adjusting for sex and well-known cardiovascular risk factors. The APRI was not a significant factor for CAD in any model. In the bivariate correlation analysis, the FIB-4 score and NFS were directly correlated with CAC scores. Conclusion Non-invasive liver fibrosis scores (FIB-4 and NFS) were significantly associated with the CAD severity and CAC scores in patients with MAFLD. Screening for CAD may be beneficial for subjects with high liver fibrosis risk MAFLD.
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Affiliation(s)
- Chuan Lu
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Yan Chen
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Yue Zhang
- Department of Gastroenterology, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
| | - Xin Zhao
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, 116023, People’s Republic of China
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Mechelinck M, Hein M, Kupp C, Braunschweig T, Helmedag MJ, Klinkenberg A, Habigt MA, Klinge U, Tolba RH, Uhlig M. Experimental Liver Cirrhosis Inhibits Restenosis after Balloon Angioplasty. Int J Mol Sci 2023; 24:11351. [PMID: 37511114 PMCID: PMC10379020 DOI: 10.3390/ijms241411351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The effect of liver cirrhosis on vascular remodeling in vivo remains unknown. Therefore, this study investigates the influence of cholestatic liver cirrhosis on carotid arterial remodeling. A total of 79 male Sprague Dawley rats underwent bile duct ligation (cirrhotic group) or sham surgery (control group) and 28 days later left carotid artery balloon dilatation; 3, 7, 14 and 28 days after balloon dilatation, the rats were euthanized and carotid arteries were harvested. Histological sections were planimetrized, cell counts determined, and systemic inflammatory parameters measured. Up to day 14 after balloon dilatation, both groups showed a comparable increase in neointima area and degree of stenosis. By day 28, however, both values were significantly lower in the cirrhotic group (% stenosis: 20 ± 8 vs. 42 ± 10, p = 0.010; neointimal area [mm2]: 0.064 ± 0.025 vs. 0.138 ± 0.025, p = 0.024). Simultaneously, cell density in the neointima (p = 0.034) and inflammatory parameters were significantly higher in cirrhotic rats. This study demonstrates that cholestatic liver cirrhosis in rats substantially increases neointimal cell consolidation between days 14 and 28. Thereby, consolidation proved important for the degree of stenosis. This may suggest that patients with cholestatic cirrhosis are at lower risk for restenosis after coronary intervention.
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Affiliation(s)
- Mare Mechelinck
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Marc Hein
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Carolin Kupp
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Till Braunschweig
- Department of Pathology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Marius J Helmedag
- Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Axel Klinkenberg
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Moriz A Habigt
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - René H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Moritz Uhlig
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
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11
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Xiong S, Yin S, Deng W, Zhao Y, Li W, Wang P, Li Z, Yang H, Zhou Y, Yu S, Guo X, Sun Y. Predictive value of liver fibrosis scores in cardiovascular diseases among hypertensive population. J Hypertens 2023; 41:741-750. [PMID: 36883472 PMCID: PMC10090336 DOI: 10.1097/hjh.0000000000003394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/27/2022] [Accepted: 01/21/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To explore the predictive value of liver fibrosis scores [fibrosis-4, AST/platelet ratio index, BAAT score (BMI Age ALT TG), and BARD score (BMI AST/ALT Ratio Diabetes)] for the risk of cardiovascular disease (CVD) in a hypertensive population. METHODS A total of 4164 hypertensive participants without history of CVD were enrolled in the follow-up. Four liver fibrosis scores (LFSs) were used, including the fibrosis-4 (FIB-4), APRI, BAAT score, and BARD score. The endpoint was CVD incidence which was defined as stroke or coronary heart disease (CHD) during the follow-up period. Cox regression analyses were used to calculate hazard ratios between LFSs and CVD. Kaplan-Meier curve was used to show the probability of CVD in different levels of LFSs. Restricted cubic spline further explored whether the relationship between LFSs and CVD was linear. Finally, we assessed the discriminatory ability of each LFS for CVD was assessed using C -statistics, net reclassification index (NRI), and integrated discrimination improvement (IDI). RESULTS During a median follow-up time of 4.66 years, 282 hypertensive participants had CVD. Kaplan-Meier curve showed that four LFSs were associated with CVD and high levels of LFSs significantly increase the probability of CVD in hypertensive population. In the multivariate Cox regression analysis, the adjusted hazard ratios for four LFSs were 3.13 in FIB-4, 1.66 in APRI, 1.47 in BAAT score, and 1.36 in BARD score. Moreover, after adding LFSs to original risk prediction model, we find that all four new models have higher C -statistics of CVD than the traditional model. Furthermore, the results of both NRI and IDI were positive, indicating that LFSs enhanced the effect on the prediction of CVD. CONCLUSIONS Our study showed that LFSs were associated with CVD in hypertensive populations in northeastern China. Furthermore, it suggested that LFSs could be a new tool for identifying patients at high risk of primary CVD in a hypertensive population.
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Affiliation(s)
- Shengjun Xiong
- Department of Cardiology, The First Hospital of China Medical University, Heping District, Shenyang, Liaoning Province, People Republic of China
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12
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He HM, He C, You ZB, Zhang SC, Lin XQ, Luo MQ, Lin MQ, Zhang LW, Lin KY, Guo YS. Non-Invasive Liver Fibrosis Scores Are Associated With Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention. Angiology 2023; 74:333-343. [PMID: 35642134 DOI: 10.1177/00033197221105745] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have demonstrated that non-invasive liver fibrosis scores (LFSs) are associated with kidney function deterioration. This study aimed to assess the predictive performance of LFSs in contrast-associated acute kidney injury (CA-AKI) in coronary artery disease (CAD) patients undergoing elective percutaneous coronary intervention (PCI). This retrospective study involved 5627 patients. The frequency of CA-AKI was 6.3% (n = 353). In a multivariate logistic analysis after adjustment, non-invasive LFSs, including fibrosis-5 score (FIB-5), fibrosis-4 score (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio (AAR), and aspartate aminotransferase to platelet ratio index were independent risk factors for CA-AKI (all P < .05), whereas the Forns score was not (P > .05). The highest predictive performance was observed for FIB-5 (area under the curve [AUC] = .644) compared to other LFSs. A restricted cubic spline analysis confirmed approximately linear relationships between LFSs and risks of CA-AKI. Furthermore, adding FIB-5 (AUC = .747; net reclassification improvement [NRI] = .441, P < .001; integrated discrimination improvement [IDI] = .008, P < .001) or AAR (AUC = .747; NRI = .419, P < .001; IDI = .006, P = .010) to an established clinical risk model could significantly improve the prediction of CA-AKI. The LFSs were significantly associated with CA-AKI, possibly serving as predictive tools for early identification of CAD patients undergoing elective PCI that are at high risk of CA-AKI.
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Affiliation(s)
- Hao-Ming He
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Chen He
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Zhe-Bin You
- Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, China
| | - Si-Cheng Zhang
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Xue-Qin Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Man-Qing Luo
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Mao-Qing Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Li-Wei Zhang
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Kai-Yang Lin
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
| | - Yan-Song Guo
- Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.,Fujian Heart Failure Center Alliance117861, Fuzhou, China
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13
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Cao Y, Guo S, Dong Y, Liu C, Zhu W. Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction. ESC Heart Fail 2023; 10:1771-1780. [PMID: 36864701 DOI: 10.1002/ehf2.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 01/13/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
AIMS Liver fibrosis scores (LFSs) are non-invasive and effective tools for estimating cardiovascular risks. To better understand the advantages and limitations of currently available LFSs, we determined to compare the predictive values of LFSs in heart failure with preserved ejection fraction (HFpEF) for primary composite outcome, atrial fibrillation (AF), and other clinical outcomes. METHODS AND RESULTS This was a secondary analysis of the TOPCAT trial, and 3212 HFpEF patients were enrolled. Five LFSs, namely, non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 score (FIB-4), BARD, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, and Health Utilities Index (HUI) scores were adopted. Cox proportional hazard model and competing risk regression model were performed to assess the associations between LFSs and outcomes. The discriminatory power of each LFS was evaluated by calculating the area under the curves (AUCs). During a median follow-up of 3.3 years, a 1-point increase in the NFS [hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.04-1.17], BARD (HR 1.19; 95% CI 1.10-1.30), and HUI (HR 1.44; 95% CI 1.09-1.89) scores was associated with an increased risk of primary outcome. Patients with high levels of NFS (HR 1.63; 95% CI 1.26-2.13), BARD (HR 1.64; 95% CI 1.25-2.15), AST/ALT ratio (HR 1.30; 95% CI 1.05-1.60), and HUI (HR 1.25; 95% CI 1.02-1.53) were at an increased risk of primary outcome. Subjects who developed AF were more likely to have high NFS (HR 2.21; 95% CI 1.13-4.32). High levels of NFS and HUI scores were a significant predictor of any hospitalization and hospitalization for heart failure. The AUCs for the NFS in predicting primary outcome (0.672; 95% CI 0.642-0.702) and incident of AF (0.678; 95% CI 0.622-0.734) were higher than other LFSs. CONCLUSIONS In light of these findings, NFS appears to have superior predictive and prognostic utility compared with AST/ALT ratio, FIB-4, BARD, and HUI scores. CLINICAL TRIAL REGISTRATION (https://clinicaltrials.gov). Unique identifier: NCT00094302.
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Affiliation(s)
- Yalin Cao
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Siyu Guo
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Wengen Zhu
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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14
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Acar B, Celikyurt U, Agacdiken A, Vural A. Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy. Pacing Clin Electrophysiol 2023; 46:251-257. [PMID: 36593653 DOI: 10.1111/pace.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 12/25/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.
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Affiliation(s)
- Burak Acar
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Umut Celikyurt
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Aysen Agacdiken
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ahmet Vural
- Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Kocaeli University Medical Faculty, Kocaeli, Turkey
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15
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Clinical Implications of Cardiac Symptoms and Electrocardiographic Abnormalities for Advanced Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020375. [PMID: 36837575 PMCID: PMC9959224 DOI: 10.3390/medicina59020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Background and Objectives: Advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) can be a major predictor of cardiovascular disease (CVD) events and cardiac complications. However, the clinical significance of cardiac symptoms and abnormal electrocardiography (ECG) findings in patients with NAFLD associated with advanced liver fibrosis is unclear. Therefore, our study was aimed to evaluate the clinical implications based on the association between cardiac symptoms with ECG abnormalities for advanced liver fibrosis in patients with NAFLD. Materials and Methods: Of 31,795 participants who underwent health checkups, 6293 were diagnosed with NAFLD using ultrasound and inclusion criteria in a retrospective cross-sectional study. Advanced liver fibrosis was assessed based on a low NAFLD fibrosis score (NFS) and fibrosis-4 index (Fib-4) cut-off values (COVs). Cardiac data were assessed using a cardiac symptom questionnaire and 12-lead electrocardiography (ECG). Results: Among 6293 NAFLD patients with NAFLD, 304 (4.8%) experienced cardiac symptoms. NFS and Fib-4 indicated higher rates of advanced fibrosis in the cardiac-symptomatic group than in the non-symptomatic group (NFS: 7.3 vs. 4.1%; Fib-4: 7.8 vs. 3.7%; both p < 0.001). Cardiac symptoms were independently associated with advanced liver fibrosis using a step-wise-adjusted model and NFS and Fib-4 (final adjusted odds ratio (aOR), 1.40; 95% CI, 1.06-1.85; p = 0.018 for NFS; aOR, 1.67; 95%, 1.30-2.15; p < 0.001 for Fib-4). Cardiac symptoms with abnormal ECG findings independently predicted advanced liver fibrosis (aOR, 2.43; 95% CI, 1.72-3.39; p < 0.001 for NFS; aOR, 3.02; 95% CI, 2.19-4.15; p < 0.001 for Fib-4). Conclusions: Patients who have had cardiac symptoms and some ECG abnormalities may have a higher association with advanced liver fibrosis.
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16
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Xiong S, Wang P, Yin S, Deng W, Zhao Y, Li W, Li Z, Zhou Y, Yu S, Yang H, Guo X, Sun Y. The association between liver fibrosis scores and chronic kidney disease. Front Med (Lausanne) 2023; 10:1046825. [PMID: 36793875 PMCID: PMC9922852 DOI: 10.3389/fmed.2023.1046825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose This study aimed to clarify the relationship between liver fibrosis scores (Fibrosis-4, BARD score, and BAAT score) and chronic kidney disease (CKD). Methods We collected a range of data from 11,503 subjects (5,326 men and 6,177 women) from the rural regions of Northeastern China. Three liver fibrosis scores (LFSs) including fibrosis-4 (FIB-4), BARD score, and BAAT score were adopted. A logistic regression analysis was used to calculate odds ratios and the 95% confidence interval. A subgroup analysis showed the association between LFSs and CKD under different stratifications. Restricted cubic spline could further explore whether there is a linear relationship between LFSs and CKD. Finally, we used C-statistics, Net Reclassification Index (NRI), and Integrated Discrimination Improvement (IDI) to assess the effect of each LFS on CKD. Results Through the baseline characteristics, we observed that LFSs were higher in the CKD population than in non-CKD. The proportion of participants with CKD also increased with LFSs. In a multivariate logistic regression analysis, the ORs of CKD were 6.71 (4.45-10.13) in FIB-4, 1.88 (1.29-2.75) in the BAAT score, and 1.72 (1.28-2.31) in the BARD score by comparing the high level with the low level in each LFSs. Moreover, after adding LFSs to the original risk prediction model, which consisted of age, sex, drinking, smoking, diabetes, low-density lipoprotein cholesterol, total cholesterol, triglycerides, and mean waist circumference, we found the new models have higher C-statistics. Furthermore, NRI and IDI both indicate LFSs had a positive effect on the model. Conclusions Our study showed that LFSs are associated with CKD among middle-aged populations in rural areas of northeastern China.
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17
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Yan Z, Liu Y, Li W, Zhao X, Lin W, Zhang J, Yu S, Ma J, Wang J, Yu P, Li W, Liu X. Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13855. [PMID: 36001034 DOI: 10.1111/eci.13855] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with nonalcoholic fatty liver disease, liver fibrosis was associated with a higher risk of cardiovascular events. However, the relationship between liver fibrosis scores and clinical outcomes in patients with cardiovascular disease remains unclear. METHODS Searching from PubMed, EMBASE and Cochrane Library databases yielded cohort studies that reported adjusted effect size between liver fibrosis scores (Fibrosis-4 score [FIB-4] or NAFLD fibrosis score [NFS]) and prognosis in patients with cardiovascular disease. The effect size was computed using a random-effects model. RESULTS This meta-analysis included twelve cohort studies involving 25,252 patients with cardiovascular disease. Participants with the highest baseline level of FIB-4 or NFS had a significantly increased risk of cardiovascular events (FIB-4, HR: 1.75, 95% CI: 1.53-2.00, I 2 = 0%; NFS, HR: 1.92, 95% CI: 1.50-2.47, I 2 = 47%). This finding was consistent with the analysis of FIB-4 or NFS as a continuous variable (per 1-unit increment FIB-4, HR: 1.15, 95% CI: 1.06-1.24, I 2 = 72%; NFS, HR: 1.15, 95% CI: 1.07-1.24, I 2 = 71%). Furthermore, participants with the highest levels of FIB-4 or NFS had a greater risk of cardiovascular mortality (FIB-4, HR: 2.07, 95% CI: 1.19-3.61, I 2 = 89%; NFS, HR: 3.72, 95% CI: 2.62-5.29, I 2 = 60%) and all-cause mortality (FIB-4, HR: 1.81, 95% CI: 1.24-2.66, I 2 = 90%; NFS, HR: 3.49, 95% CI: 2.82-4.31, I 2 = 25%). This result was also consistent as a continuous variable. CONCLUSION Higher levels of FIB-4 and NFS are related to an increased risk of cardiovascular events, cardiovascular mortality and all-cause mortality in patients with cardiovascular disease.
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Affiliation(s)
- Zhiwei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
| | - Yang Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Li
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
| | - Xiaopeng Zhao
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
| | - Weichun Lin
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuchun Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen University, Guangzhou, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiguang Li
- Liaoning Province Jinqiu Hospital, Shenyang, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen University, Guangzhou, China
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18
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Xiong S, Yin S, Deng W, Zhao Y, Li W, Wang P, Li Z, Yang H, Zhou Y, Yu S, Guo X, Sun Y. Impact of liver fibrosis score on the incidence of stroke: A cohort study. Liver Int 2022; 42:2175-2185. [PMID: 35789194 DOI: 10.1111/liv.15359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/24/2022] [Accepted: 07/04/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose was to explore the value of liver fibrosis scores (fibrosis-4, BAAT score and BARD score) for incidence risk of stroke in a cohort study. METHODS A total of 9088 participants without stroke history enrolled the follow-up. Three liver fibrosis scores (LFSs) including FIB-4, BARD score and BAAT score were adopted. The end point was stroke. Cox regression analysis was used to calculate hazard ratios and 95% confidence interval. Kaplan-Meier curve was used to show the probability of stoke in different levels of LFSs. Subgroup analysis showed the association between LFSs and stroke under different stratification. Restricted cubic spline could further explore whether there is a linear relationship between LFSs and stroke. Finally, we used C-statistics, Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) to assess the discriminatory power of each LFS for stroke. RESULTS During a median follow-up time of 4.66 years, 272 participants had a stroke. Through the baseline characteristics, we observed that the stroke incidence population tends to be male and older. It was shown by Kaplan-Meier that three LFSs were associated with stroke and high levels of LFSs significantly increase the probability of stroke. In the univariate Cox regression analysis, the HR of stroke risk was 6.04 (4.14-8.18) in FIB-4, 2.10 (1.45-3.04) in BAAT score and 1.81 (1.38-2.38) in BARD score by comparing the high level with the low level at each LFSs. The adjusted HRs for three LFSs were 2.05 (1.33-3.15) in FIB-4, 1.61 (1.10-2.35) in BAAT score and 1.54 (1.17-2.04) in BARD score by comparing the high group with low group. We found that multivariable-adjusted HRs of three LFSs still increased for stroke when stratified by various factors in subgroup analysis. Moreover, after adding LFSs to original risk prediction model which consist of age, sex, drinking, smoking, hypertension, diabetes, low-density lipoprotein cholesterol, total cholesterol and triglycerides, we found that new models have higher C-statistics of stroke. Furthermore, we calculated Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) to show the ability of LFSs to predict stroke. CONCLUSIONS Our study showed that three LFSs were associated with stroke amongst middle-aged populations in rural areas of Northeast China. Furthermore, it suggests that LFSs can be used as a risk stratification tool to predict stroke.
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Affiliation(s)
- Shengjun Xiong
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Shizhang Yin
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wanshu Deng
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yuanhui Zhao
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenhang Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Pengbo Wang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Ying Zhou
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
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19
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Xu Q, Zhang X, Li H, Tian X, Zuo Y, Zhang Y, Zhang X, Wang Y, Wang A, Meng X. Aspartate aminotransferase to alanine aminotransferase ratio and clinical outcomes after acute ischemic stroke: the CNSR-III registry. Intern Emerg Med 2022; 17:1987-1996. [PMID: 35986833 DOI: 10.1007/s11739-022-03059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
Elevated aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) has been associated with cardiovascular diseases and mortality. The clinical significance of AAR in the prognosis of stroke has yet to be established. We aimed to investigate the associations between AAR levels and clinical outcomes in acute ischemic stroke (AIS) or transient ischemic attack (TIA). Patients with AIS or TIA in the Third China National Stroke Registry (CNSR-III) were divided into four groups by quartiles of AAR, and two groups according to AAR < 1 and AAR ≥ 1. Multivariable Cox regression for all-cause mortality and logistic regression for poor functional outcome (modified Rankin Scale, mRS 3-6/2-6) were adopted to explore the associations between AAR and clinical outcomes at 3 months and 1 year. Among 10,877 included patients, the median AAR was 1.06 (interquartile range [IQR], 0.82 to 1.36). In the multivariable-adjusted model, patients in the fourth AAR quartile had higher risk of all-cause mortality within 3 months and 1 year (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.25 to 3.47; HR 2.26, 95% CI 1.55 to 3.27), and mRS 3-6/2-6 at 1 year (odds ratio [OR] 1.29, 95% CI 1.07 to 1.55; OR 1.20, 95% CI 1.02 to 1.42), compared with those in the first quartile. Similar associations were also observed when AAR ≥ 1 compared with AAR < 1. Elevated AAR was associated with higher risk of all-cause mortality and poor functional outcome after AIS or TIA, and should be carefully assessed after admission.
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Affiliation(s)
- Qin Xu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaofan Zhang
- The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yijun Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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20
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Briansó-Llort L, Fuertes-Rioja L, Ramos-Perez L, Salcedo-Allende MT, Hernandez C, Simó R, Selva DM. Transforming growth factor-beta 1: A new factor reducing hepatic SHBG production in liver fibrosis. J Cell Physiol 2022; 237:3598-3613. [PMID: 35762039 DOI: 10.1002/jcp.30818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/07/2022]
Abstract
Low plasma sex hormone-binding globulin (SHBG) levels are present in fatty liver disease, which represents a spectrum of diseases ranging from hepatocellular steatosis through steatohepatitis to fibrosis and irreversible cirrhosis. We have previously determined that fat accumulation reduces SHBG production in different nonalcoholic fatty liver disease mouse models. In the present work, we are interested in elucidating the molecular mechanisms reducing SHBG plasma levels in liver fibrosis. For this purpose, in vivo studies were performed using the human SHBG transgenic mice developing liver fibrosis induced by carbon tetrachloride (CCl4 ). Our results clearly showed that CCl4 induced liver fibrosis and reduced SHBG production by reducing hepatocyte nuclear factor 4 alpha (HNF-4α). The SHBG reduction could be influenced by the increase in transforming growth factor-beta 1 (TGF-β1), which was increased in mice developing liver fibrosis. Therefore, we decided to evaluate the role of TGF-β1 in regulating hepatic SHBG production. Results obtained in both HepG2 cells and human SHBG transgenic mice showed that TGF-β1 reduced significantly SHBG messenger RNA and protein levels. Mechanistically TGF-β1 downregulated P1-HNF-4α isoforms and increased P2-HNF-4α isoforms via Smad3 and Stat3 pathways through TGF-β1 receptor I, resulting in transcriptional repression of the SHBG gene. Taken together, we found for the first time that TGF-β1 is a new factor regulating hepatic SHBG production in liver fibrosis. Further research is needed to determine the role of this reduction in hepatic SHBG production in the progression of nonalcoholic steatohepatitis.
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Affiliation(s)
- Laura Briansó-Llort
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Lidia Fuertes-Rioja
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Lorena Ramos-Perez
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Cristina Hernandez
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - David M Selva
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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21
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Zhang P, Wang H, Bao H, Wang N, Chen Z, Tu Q, Lin X, Li Y, Zheng Z, Chen Y, Ruan L, Zhuge Q. Non-invasive Liver Fibrosis Scores Are Associated With Recurrence of Postoperative Chronic Subdural Hematoma. Front Neurol 2022; 13:873124. [PMID: 35769370 PMCID: PMC9236226 DOI: 10.3389/fneur.2022.873124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Although liver diseases have already been identified as a risk factor for increased recurrence and mortality in patients with chronic subdural hematoma (CSDH), the association between subclinical liver disease, specifically liver fibrosis (LF), and CSDH remains unknown. In the present study, we aimed to investigate the association between the LF scores and CSDH recurrence. Methods We retrospectively analyzed consecutive patients with CSDH who underwent burr-hole irrigation in the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2018. The clinical data were collected, and the LF scores were calculated including aspartate aminotransferase–platelet ratio index (APRI), fibrosis-4 (FIB-4), and Forns index. Multivariable logistic regression analysis was applied to identify the association between the LF scores and CSDH recurrence, and Cox regression model and Fine–Gray competing risks model were performed to calculate hazard ratios (HRs) for CSDH recurrence based on time-to-event outcomes. The C-statistic, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI) evaluated the additive value of the LF scores to predict the recurrence of CSDH. Results A total of 419 patients with CSDH were included, hematoma recurrence was observed in 62 patients (14.80%) within 1 year after surgery. The LF scores were significantly higher in those who recurred, whereas the standard hepatic assays were mostly normal. The patients were assigned to groups of high and low LF scores based on the validated cut-offs; compared with the subjects with low scores, those with high score levels had significantly higher recurrence rates. After adjusting for potential confounders, the LF scores were independently associated with CSDH recurrence, multivariable-adjusted HRs (95% CI) for those with higher levels of APRI, FIB-4, and Forns score were 4.32 (1.37–13.60), 2.56 (1.20–5.43), and 2.02 (1.07–3.79) for the recurrence of CSDH, respectively. Moreover, adding the APRI to the conventional model improved the C-statistic from 0.731 to 0.763, with an NRI and IDI of 7.50 and 1.35%, respectively. Two further commonly-used LF score indices (FIB-4 score and Forns index) yielded comparable results. Conclusions The data from this study first indicated that the high LF scores were significantly associated with the recurrence of CSDH and that careful follow-up in these patients may be needed.
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Affiliation(s)
- Peng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han Bao
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ning Wang
- Neurointerventional Department, Zhejiang Hospital, Hangzhou, China
| | - Zhen Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi Tu
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Lin
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Li
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zezheng Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linhui Ruan
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Linhui Ruan
| | - Qichuan Zhuge
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Qichuan Zhuge
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Thévenot T, Vendeville S, Weil D, Akkouche L, Calame P, Canivet CM, Vanlemmens C, Richou C, Cervoni JP, Seronde MF, Di Martino V, Boursier J. Systematic screening for advanced liver fibrosis in patients with coronary artery disease: The CORONASH study. PLoS One 2022; 17:e0266965. [PMID: 35617294 PMCID: PMC9135299 DOI: 10.1371/journal.pone.0266965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
Although coronary artery disease (CAD) and advanced liver fibrosis (AdLF) are commonly associated in patients with non-alcoholic fatty liver disease (NAFLD), the prevalence of AdLF and the diagnostic performance of non-invasive fibrosis tests (NITs) in CAD patients remains unknown. We aimed to prospectively screen for AdLF in patients with documented CAD using NITs and Fibroscan. High and intermediate zones of NITs were combined to define AdLF. AdLF was suspected whenever APRI ≥ 0.5, Forns index ≥ 4.2, NAFLD fibrosis score (NFS) ≥ -1.455/0.12 for age </≥ 65 yrs), Fib4 (≥ 1.30/2.0 for age </≥ 65 yrs) and eLIFT≥ 8. A presumed AdLF assessed by Fibroscan ≥ 8 kPa was the primary outcome measure. Results were given on the basis of intent-to-diagnose liver stiffness ≥ 8 kPa. Among 189 patients (age 60±7years), 10 (5.3%) had a Fibroscan ≥ 8 kPa, of whom 5 underwent liver biopsy (F3/F4: n = 3; no fibrosis: n = 2). AdLF was suspected in 31% of cases using eLIFT (specificity, Sp 70%), 85% with Forns (Sp 16%), 38% with NFS (Sp 63%), 25% with Fib4 (Sp 74%), and 10% with APRI (Sp 91%). In 149 patients “at-risk” of NAFLD (i.e., elevated ALT or diabetes or hypertriglyceridemia or BMI ≥25 kg/m2), AdLF ranged between 10% (APRI) to 84% (Forns). In this subgroup, the most efficient NITs to predict Fibroscan ≥ 8 kPa were eLIFT (Se 60%, Sp 70%) and NFS (Se 70%, Sp 60%). Finally, in CAD patients with risk factors for NAFLD, NFS or the more user-friendly eLIFT are the most attractive first-line biochemical NITs to discriminate good candidates for Fibroscan.
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Affiliation(s)
- Thierry Thévenot
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
- * E-mail:
| | - Sophie Vendeville
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | - Delphine Weil
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | - Linda Akkouche
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Paul Calame
- Department of Radiology, University Hospital Jean Minjoz, Besançon, France
| | - Clémence M. Canivet
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
| | - Claire Vanlemmens
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | - Carine Richou
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | - Jean-Paul Cervoni
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | | | - Vincent Di Martino
- Department of Hepatology, University Hospital Jean Minjoz, Besançon, France
| | - Jérôme Boursier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France
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23
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Liu HH, Cao YX, Jin JL, Hua Q, Li YF, Guo YL, Zhu CG, Wu NQ, Gao RL, Li JJ. Liver Fibrosis Scoring Systems as Novel Tools for Predicting Cardiovascular Outcomes in Patients Following Elective Percutaneous Coronary Intervention. J Am Heart Assoc 2021; 10:e018869. [PMID: 33506689 PMCID: PMC7955446 DOI: 10.1161/jaha.120.018869] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Previous studies have suggested a strong association of liver fibrosis scores (LFSs) with cardiovascular outcomes in patients with different cardiovascular diseases. Nonetheless, it is basically blank regarding the prognostic significance of LFSs in patients following percutaneous coronary intervention (PCI). This study sought to examine the potential role of LFSs in predicting long‐term outcomes in a large cohort of patients with stable coronary artery disease after elective PCI. Methods and Results In this multicenter, prospective study, we consecutively enrolled 4003 patients with stable coronary artery disease undergoing PCI. Eight currently available noninvasive LFSs were assessed for each subject. All patients were followed up for the occurrence of cardiovascular events including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average follow‐up of 5.0±1.6 years, 315 (7.87%) major cardiovascular events were recorded. Subjects who developed cardiovascular events were more likely to have intermediate or high LFSs, including nonalcoholic fatty liver disease fibrosis score; fibrosis‐4 score; body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score (BARD); and aspartate aminotransferase/alanine aminotransferase ratio. Furthermore, compared with subjects with low scores, those with intermediate plus high score levels had significantly increased risk of cardiovascular events (adjusted hazard ratios ranging 1.57–1.92). Moreover, the addition of non‐alcoholic fatty liver disease fibrosis score; fibrosis‐4 score; or body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score into a model with established cardiovascular risk factors significantly improved the prediction ability. Conclusions High LFSs levels might be useful for predicting adverse prognosis in patients with stable coronary artery disease following PCI, suggesting the possibility of the application of LFSs in the risk stratification before elective PCI.
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Affiliation(s)
- Hui-Hui Liu
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ye-Xuan Cao
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jing-Lu Jin
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qi Hua
- Department of Cardiology XuanWu HospitalCapital Medical University Beijing China
| | - Yan-Fang Li
- Department of Cardiology Beijing AnZhen HospitalCapital Medical University Beijing China
| | - Yuan-Lin Guo
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Cheng-Gang Zhu
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Na-Qiong Wu
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Run-Lin Gao
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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