Boston University School of Medicine, Boston, MA, USA.
Yale University School of Medicine, New Haven, CT, USA.
Prog Cardiovasc Dis. 2020 Mar-Apr;63(2):184-191. doi: 10.1016/j.pcad.2020.02.010. Epub 2020 Feb 15.
Liver fibrosis, is independently associated with incident heart failure (HF). Investigating the association between liver fibrosis and type of HF, specifically HF with reduced ejection fraction (EF; HFrEF) or HF with preserved ejection fraction (HFpEF), may provide mechanistic insight into this association. We sought to determine the association between liver fibrosis score (FIB-4) and type of HF, and to assess whether HIV or hepatitis C status modified this association.
We included patients alive on or after 4/1/2003 from the Veterans Aging Cohort Study. We followed patients without prevalent cardiovascular disease until their first HF event, death, last clinic visit, or 9/30/2015. We defined liver fibrosis as: likely advanced fibrosis (FIB-4 > 3.25), indeterminate (FIB-4 range 1.45-3.25), unlikely advanced fibrosis (FIB-4 < 1.45). Primary outcomes were HFrEF and HFpEF (defined using ICD-9 diagnoses for HF, and EF extracted from electronic medical records using natural language processing). Cox proportional hazards models were adjusted for potential confounders and used to estimate hazard ratios (HR).
Among 108,708 predominantly male (96%) participants mean age was 49 years. Likely advanced fibrosis was present in 4% at baseline and was associated with an increased risk of HFpEF [HR (95% confidence interval)] [1.70 (1.3-2.3)]; and non-significantly with HFrEF [1.20 (0.9-1.7)]. These associations were not modified by HIV or hepatitis C status.
Likely advanced fibrosis was independently associated with incident HFpEF but not HFrEF. This suggests that risk factors and/or mechanisms for liver fibrosis may have greater overlap with those for HFpEF than HFrEF.
肝纤维化与心力衰竭（HF）的发生独立相关。研究肝纤维化与 HF 类型之间的关系，特别是射血分数降低的 HF（HFrEF）或射血分数保留的 HF（HFpEF），可能为这种关系提供机制上的见解。我们试图确定肝纤维化评分（FIB-4）与 HF 类型之间的关系，并评估 HIV 或丙型肝炎状态是否改变了这种关系。
我们纳入了退伍军人老龄化队列研究中 2003 年 4 月 1 日或之后存活的患者。我们随访了没有心血管疾病的患者，直到他们首次发生 HF 事件、死亡、最后一次就诊或 2015 年 9 月 30 日。我们将肝纤维化定义为：可能存在晚期纤维化（FIB-4>3.25）、不确定（FIB-4 范围 1.45-3.25）、不太可能存在晚期纤维化（FIB-4<1.45）。主要结局是 HFrEF 和 HFpEF（使用 HF 的 ICD-9 诊断和使用自然语言处理从电子病历中提取的 EF 来定义）。Cox 比例风险模型调整了潜在的混杂因素，并用于估计风险比（HR）。
在 108708 名主要为男性（96%）的参与者中，平均年龄为 49 岁。基线时存在可能的晚期纤维化占 4%，与 HFpEF 的风险增加相关[风险比（95%置信区间）] [1.70（1.3-2.3)]；与 HFrEF 无显著相关性[1.20（0.9-1.7）]。这些关联不受 HIV 或丙型肝炎状态的影响。
可能存在晚期纤维化与 HFpEF 的发生独立相关，但与 HFrEF 无关。这表明肝纤维化的危险因素和/或机制与 HFpEF 的重叠可能大于 HFrEF。
