Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 712-749, Republic of Korea.
Medicina (Kaunas). 2023 Feb 15;59(2):375. doi: 10.3390/medicina59020375.
: Advanced liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) can be a major predictor of cardiovascular disease (CVD) events and cardiac complications. However, the clinical significance of cardiac symptoms and abnormal electrocardiography (ECG) findings in patients with NAFLD associated with advanced liver fibrosis is unclear. Therefore, our study was aimed to evaluate the clinical implications based on the association between cardiac symptoms with ECG abnormalities for advanced liver fibrosis in patients with NAFLD. : Of 31,795 participants who underwent health checkups, 6293 were diagnosed with NAFLD using ultrasound and inclusion criteria in a retrospective cross-sectional study. Advanced liver fibrosis was assessed based on a low NAFLD fibrosis score (NFS) and fibrosis-4 index (Fib-4) cut-off values (COVs). Cardiac data were assessed using a cardiac symptom questionnaire and 12-lead electrocardiography (ECG). : Among 6293 NAFLD patients with NAFLD, 304 (4.8%) experienced cardiac symptoms. NFS and Fib-4 indicated higher rates of advanced fibrosis in the cardiac-symptomatic group than in the non-symptomatic group (NFS: 7.3 vs. 4.1%; Fib-4: 7.8 vs. 3.7%; both < 0.001). Cardiac symptoms were independently associated with advanced liver fibrosis using a step-wise-adjusted model and NFS and Fib-4 (final adjusted odds ratio (aOR), 1.40; 95% CI, 1.06-1.85; = 0.018 for NFS; aOR, 1.67; 95%, 1.30-2.15; < 0.001 for Fib-4). Cardiac symptoms with abnormal ECG findings independently predicted advanced liver fibrosis (aOR, 2.43; 95% CI, 1.72-3.39; < 0.001 for NFS; aOR, 3.02; 95% CI, 2.19-4.15; < 0.001 for Fib-4). : Patients who have had cardiac symptoms and some ECG abnormalities may have a higher association with advanced liver fibrosis.
非酒精性脂肪性肝病 (NAFLD) 患者的晚期肝纤维化可能是心血管疾病 (CVD) 事件和心脏并发症的主要预测因素。然而，NAFLD 相关晚期肝纤维化患者的心脏症状和异常心电图 (ECG) 发现的临床意义尚不清楚。因此，我们的研究旨在评估基于心脏症状与 ECG 异常与 NAFLD 患者晚期肝纤维化之间的相关性的临床意义。
在一项回顾性横断面研究中，对 31795 名接受健康检查的参与者进行了超声检查和纳入标准，其中 6293 名被诊断为 NAFLD。根据低 NAFLD 纤维化评分 (NFS) 和纤维化-4 指数 (Fib-4) 截断值 (COV) 评估晚期纤维化。使用心脏症状问卷和 12 导联心电图 (ECG) 评估心脏数据。
在 6293 名患有 NAFLD 的患者中，有 304 名 (4.8%) 出现心脏症状。NFS 和 Fib-4 显示在有心脏症状的组中，晚期纤维化的发生率高于无症状组 (NFS：7.3%比 4.1%；Fib-4：7.8%比 3.7%；均 < 0.001)。使用逐步调整模型和 NFS 及 Fib-4，心脏症状与晚期肝纤维化独立相关 (最终调整后的优势比 (aOR)，1.40；95%可信区间，1.06-1.85；= 0.018 用于 NFS；aOR，1.67；95%可信区间，1.30-2.15；< 0.001 用于 Fib-4)。有心脏症状和异常心电图发现的患者独立预测晚期肝纤维化 (aOR，2.43；95%可信区间，1.72-3.39；< 0.001 用于 NFS；aOR，3.02；95%可信区间，2.19-4.15；< 0.001 用于 Fib-4)。
综上所述，有心脏症状和一些心电图异常的患者可能与晚期肝纤维化有更高的相关性。
