Progression of Liver Fibrosis in Patients with Stable Coronary Heart Disease Combined with Non-Alcoholic Fatty Liver Disease

I.I. Vakalyuk, N.G. Virstyuk, V.M. Kazmiruk

Abstract


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.


Keywords


stable coronary heart disease; non-alcoholic fatty liver disease; liver parenchymal stiffness; elastography

References


Gorbas I.M., Barna O.M., Sakalosh V.Yu. Ocinka poshyrenosti ta kontrolyu faktoriv ryzyku sercevo-sudynnyx zaxvoryuvan sered naselennya ta likariv [Evaluation of prevalence and control of risk factors of cardiovascular disease in the population and doctors]. Liky Ukrayiny [Medicines of Ukraine], 2010, no.1. pp. 4-9.

Fazlyeyeva V. Suchasna kardiologiya: kvalifikovanyj pidxid do xvoryx na vsix etapax medychnoyi dopomogy: (pidsumky roboty XII Nacionalnogo kongresu kardiologiv 21-23 veresnya 2011 r. m. Kyiv [Modern cardiology, qualified approach to patients at all stages of care: (results of the XII National Congress of Cardiology on 21-23 September 2011 Kyiv]. Liky Ukrayiny [Medicines of Ukraine], 2011, no.9(155). pp. 109-110.

Kravchenko V.V., Sokolov M.Yu., Talayeva T.V. Unifikovanyj klinichnyj protokol "Stabilna ishemichna xvoroba sercya". Nakaz MOZ Ukrayiny no.152 vid 02.03.2016 roku [Unified Clinical Protocol "Stable coronary heart disease." MOH Ukraine Order #152 from 03.02.2016].

Dynnyk O.B., Myxalchyshn G.P., Kobylyak N.M. Zhorstkist pechinky za danymy zsuvnoxvylovoyi elastografiyi u xvoryx na czukrovyj diabet typu 2 z nealkogolnoyu zhyrovoyu xvoroboyu pechinky zalezhno vid aktyvnosti procesu NAZhXP [The liver stiffness according to the shear wave elastography in patients with diabetes mellitus type 2 with non-alcoholic fatty liver disease depending on the activity of the NAFLD process]. Gastroenterologiya [Gastroenterology], 2014, no.3(53). pp.24-29.

Fadyeyenko G.D., Gridnyev O.Ye., Nesen A.O. Komorbidnist i vysokyj kardiovaskulyarnyj ryzyk - klyuchovi pytannya suchasnoyi medycyny [Сomorbidity and high cardiovascular risk - key issues of modern medicine]. Ukrayinskyj terapevtychnyj zhurnal [Ukrainian Journal of Therapeutics], 2013, no.1 pp. 102-107.

Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart disease / M. Gaggini, M. Morelli, E. Buzzigoli [et al.] // Nutrients. – 2013. – Vol. 5. – P. 1544-1560.

Bodnar P.M. Nealkogolna zhyrova xvoroba pechinky u xvoryx na czukrovyj diabet typu 2: patogenez, diagnostyka ta likuvannya [Non-alcoholic fatty liver disease in patients with diabetes mellitus type 2: pathogenesis, diagnosis and treatment]. Endokrynologiya [Endocrinology], 2012, issue17. no.1. pp. 94-101.

Xobzej M.K., Xarchenko N.V., Lishhyshyna O.M. Unifikovanyj klinichnyj protokol "Nealkogolnyj steatogepatyt". Nakaz MOZ Ukrayiny no. 826 vid 06.11.2014 [Unified Clinical Protocol "Non-alcoholic steatohepatitis". MOH Ukraine Order #826 from 06.11.2014].

Dolzhenko M.M. Vplyv nealkogolnoyi zhyrovoyi xvoroby pechinky na perebig ishemichnoyi xvoroby sercya za danymy dvorichnogo sposterezhennya [The impact of non-alcoholic fatty liver disease in the course of coronary heart disease according to a two-year observation]. Ukrayinskyj kardiologichnyj zhurnal [Ukrainian Journal of Cardiology], 2011, no.2. pp. 67-70.

Yki-Jarvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome / H. Yki-Jarvinen // Lancet Diabetes Endocrinol. – 2014. – Vol. 2(11). – P. 901-910.

Bazylevych A.Ya. Nealkogolnyj steatogepatyt yak nov`j faktor rozvytku ishemichnoyi xvoroby sercya [Non-alcoholic steatohepatitis as a new factor for coronary heart disease]. Scientific Journal «ScienceRise» [Scientific Journal «ScienceRise»], 2015, no.10/3(15). Pp.171-175.

Diagnosis of experimental steatohepatosis using ultrasound shear wave elastography / P. M. Bodnar, O. B. Dynnik, G. P. Mykhalchyshyn [et al.] // Current Issues in Pharmacy and Medical Sciences. – 2013. – Vol. 26, № 1. – P. 97–101.

World Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis / R. LaBrecque Douglas, Abbas Zaigham, Anania Frank [et al.] // Journal of Clinical Gastroenterology. – 2014. – Vol. 48 - Issue 6 – P. 467–473.

Bodnar P.M., Dynnyk O.B., Myxalchyshyn G.P. Ocinka diagnostychnoyi efektyvnosti elastografiyi xvyli zsuvu u xvoryx na czukrovyj diabet 2 typu z nealkogolnym steatogepatozom [Evaluation of diagnostic efficiency of shear waves elastography in patients with diabetes mellitus type 2 with non-alcoholic steatohepatosis]. Endokrynologiya [Endocrinology], 2012, issue17. no.3. pp.38-48.

European Association for the study of the Liver, Association Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of the liver disease severity and prognosis / J Hepatol. – 2015. – Vol. 63. – P.237-264.

Dyinnik O.B., Linskaya A.V., Kobyilyak N.N. Cdvigovovolnovaya elastografiya i elastometriya parenhimyi pecheni (metodicheskie aspektyi) [The shear wave elastography and elastometry liver parenchyma (methodological aspects)]. Promeneva diagnostyka, promeneva terapiya [Radiation diagnostics, radiation therapy], 2014, no.12. pp.73-82.

Dynnyk O.B., Zhajvoronok M.M., Kobylyak N.M. Ultrazvukova elastografiya: teoriya i praktyka stvorennya navchalnogo trenazheru [Ultrasound Elastohraphy: theory and practice of creating training simulator]. Promeneva diagnostyka, promeneva terapiya [Radiation diagnostics, radiation therapy], 2014, no.3. pp.42-53.

Kumar, R., Rastogi, A., Sharma, M.K., Bhatia, V., Tyagi, P., Sharma, P. et al. Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease: diagnostic performance and clinicopathological correlation. Dig Dis Sci. 2013; 58: 265–274

Machado M. V. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal / M. V. Machado, H. Cortez-Pinto // J Hepatol. – 2013. – Vol. 58. – P. 1007–1019.

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease Journal of Hepatology. – 2016. – Vol. 64(6). – P. 1388–1402.

Shear Wave Elastography for Evaluation of Liver Fibrosis / G. Ferraioli, P. Parekh, A. B. Levitov [et al.] // Journal of Ultrasound in Medicine. – 2014. – Vol. 33, no. 2. – P. 197-203.




DOI: https://doi.org/10.22141/2308-2097.4.62.2016.81088

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru