Progression of Liver Fibrosis in Patients with Stable Coronary Heart Disease Combined with Non-Alcoholic Fatty Liver Disease
Purpose — to assess the liver stiffness in patients with stable coronary heart disease (CHD) combined with non-alcoholic fatty liver disease (NAFLD) depending on the severity of coronary atherosclerosis. Materials and methods. The study included 220 patients with stable CHD combined with NAFLD. Among them, patients with non-alcoholic steatosis (NAFS) and non-alcoholic steatohepatitis (NASH) were observed. The control group consisted of 20 apparently healthy individuals. All patients underwent general clinical examination, electrocardiography, coronary angiography, elastography, assessment of the liver functional state. Results. Analysis of the findings revealed an increase in liver stiffness in all groups of patients compared to the control group. In particular, in patients with NAFLD shear wave velocity was significantly higher than the value in healthy individuals in al groups. Indicator of liver parenchyma stiffness was increased more than twice from the level of the control group in patients with NASH. Significant difference of the state of the liver parenchyma was found depending on the stage of NAFLD. Analysis of the stages of fibrotic liver changes revealed certain patterns depending on NAFLD progression. In particular, F1 stage of liver fibrosis occurred in more than half of the patients from group IА (р < 0.05). In IB group on the background of NASH, F2 stage of liver fibrosis was found in about 60 % of patients (р < 0.05), and F3 stage — in 25.0 % of patients. Stages of fibrosis did not differ significantly in the patients of group II as compared to the group I. The most prognostically unfavorable course of NAFLD was detected in group III. Thus, 34.8 % of patients from IIIA group had F2 stage of fibrosis, in the case of NASH, more than 70 % of patients from IIIB group had significant fibrotic changes of liver parenchyma of F3 stage (p < 0.05). Moreover, over 13 % of patients from IIIB group had F4 stage of fibrosis. Conclusions. NAFLD course in patients with stable CHD is characterized by increased stiffness of the liver parenchyma that significantly depends on the stage of NAFLD and is most pronounced on the background of NASH. The progression of liver fibrosis in patients with NAFLD associated with stable CHD depends on the extent of coronary atherosclerosis and is the most prognostically unfavorable in patients with acute coronary syndrome and severe scarring of the myocardium.
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