Takahashi Tetsuya, Watanabe Tetsu, Shishido Tetsuro, Watanabe Ken, Sugai Takayuki, Toshima Taku, Kinoshita Daisuke, Yokoyama Miyuki, Tamura Harutoshi, Nishiyama Satoshi, Arimoto Takanori, Takahashi Hiroki, Yamanaka Tamon, Miyamoto Takuya, Kubota Isao
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Heart Vessels. 2018 Jul;33(7):733-739. doi: 10.1007/s00380-017-1113-1. Epub 2017 Dec 29.
Liver abnormalities have a strong impact on clinical outcomes in patients with heart failure (HF), and are known as cardio-hepatic syndrome. The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been developed to identify liver fibrosis in patients with NAFLD. It remains to be determined whether NFS is associated with cardiovascular prognosis in patients with chronic heart failure (CHF). We calculated NFS in 516 patients with CHF admitted to our hospital. The clinical endpoints were deaths due to progressive HF, myocardial infarction, stroke, and sudden cardiac death, and rehospitalization for worsening HF. There were 173 cardiovascular events noted during a median follow-up of 464 days. Patients with cardiovascular events showed a higher NFS as compared with those without. We divided the patients into four groups according to quartiles of NFS. The proportion of New York Heart Association functional class III/IV and serum brain natriuretic peptide levels were increased with increasing NFS. Kaplan-Meier analysis revealed that cardiovascular event rate was increased with increasing NFS in patients with CHF. In multivariate Cox proportional hazards analysis, NFS was independently associated with cardiovascular events after adjustment for confounding factors. Elevated NFS was associated with unfavorable outcomes in patients with CHF. Liver fibrosis assessed by NFS may provide valuable prognostic information in patients with CHF.
肝脏异常对心力衰竭（HF）患者的临床结局有重大影响，这被称为心-肝综合征。非酒精性脂肪性肝病（NAFLD）纤维化评分（NFS）已被用于识别NAFLD患者的肝纤维化情况。NFS是否与慢性心力衰竭（CHF）患者的心血管预后相关仍有待确定。我们计算了我院收治的516例CHF患者的NFS。临床终点为因进行性HF、心肌梗死、中风和心源性猝死导致的死亡，以及因HF恶化再次住院。在中位随访464天期间记录到173例心血管事件。发生心血管事件的患者的NFS高于未发生事件的患者。我们根据NFS四分位数将患者分为四组。纽约心脏协会功能分级III/IV级的比例和血清脑钠肽水平随NFS升高而增加。Kaplan-Meier分析显示，CHF患者的心血管事件发生率随NFS升高而增加。在多变量Cox比例风险分析中，调整混杂因素后，NFS与心血管事件独立相关。NFS升高与CHF患者的不良结局相关。通过NFS评估的肝纤维化可能为CHF患者提供有价值的预后信息。
