FSTL3 partially mediates the association of increased nonalcoholic fatty liver disease fibrosis risk with acute myocardial infarction in patients with type 2 diabetes mellitus

Circulating follistatin-like 3 and its association with postpartum cardiovascular dysfunction and severe maternal morbidity

OBJECTIVES

Despite postpartum cardiovascular dysfunction being the leading cause of pregnancy-related mortality in the United States, it is difficult to identify at-risk patients. The objective of this study was to determine if antepartum follistatin-like 3 levels correlate with postpartum cardiovascular dysfunction and maternal morbidity.

STUDY DESIGN

This observational cohort study included pregnant patients ≥ 18 years old and singleton gestation < 41 weeks who delivered at the University of Chicago between May 2017 and November 2020.

MAIN OUTCOME MEASURES

The primary outcome was postpartum cardiovascular dysfunction, defined as postpartum hypertension, cardiomyopathy, and pulmonary edema. The secondary outcome was severe maternal morbidity.

RESULTS

The final cohort included 408 women. Elevated FSTL3 levels were associated with postpartum cardiovascular dysfunction (OR per unit increase in FSTL3, 1.02 [95 % CI: 1.01, 1.04]; p < 0.001). After adjustment for gestational age at delivery, maternal age, BMI, nulliparous status, hypertensive disorders of pregnancy, smoking, and diabetes, the association between FSTL3 levels and cardiovascular dysfunction persisted (p = 0.03), with good model discrimination between events (c-statistic 0.88). FSTL3 levels were also associated with severe maternal morbidity (OR per unit increase 1.02 [95 % CI: 1.01, 1.03]; p < 0.0001). Additionally, Activin A levels were associated with cardiovascular dysfunction and severe maternal morbidity (c = 0.84, p = 0.01; c = 0.87, p = 0.02 respectively).

CONCLUSIONS

Higher follistatin-like 3 levels were associated with postpartum cardiovascular dysfunction and severe maternal morbidity. Follistatin-like 3 may be causal in cardiovascular dysfunction, and further work should define its potential as a biomarker.

Relationship Between Liver Fibrosis and Increased Risk of Symptomatic Intracranial Hemorrhage in Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Background

Liver fibrosis has been reported to be associated with hematoma expansion and mortality in patients with intracerebral hemorrhage. This study aimed to detect the association between liver fibrosis and symptomatic intracranial hemorrhage (sICH) in ischemic stroke after mechanical thrombectomy (MT).

Methods

We retrospectively included patients with large artery occlusion in the anterior circulation and treated with MT at a single stroke center. The fibrosis-4 index (FIB-4) was used to assess the severity of liver fibrosis. sICH was diagnosed according to the Heidelberg Bleeding Classification criteria. Multivariate logistic regression and restricted cubic spline analysis were conducted to examine the relationship between liver fibrosis and sICH.

Results

Among the 578 patients (mean age, 70.1 years; 58.5% male) included in the study, 65 (11.2%) individuals were diagnosed with sICH. After adjusting for demographic characteristics and other potential confounders, a higher FIB-4 index was found to be independently associated with an increased risk of sICH (odds ratio: 1.306, 95% confidence interval: 1.127-1.512, P=0.001). Similar results were obtained when analyzing FIB-4 as a categorical variable.

Conclusion

This study demonstrated that there is a significant association between FIB-4 and the risk of sICH in patients with acute ischemic stroke who underwent MT. Therefore, liver fibrosis could serve as a valuable parameter in monitoring the risk of sICH following MT.