Abdu Fuad A, Mareai Redhwan M, Xiang Lanqing, Galip Jassur, Mohammed Abdul-Quddus, Zhang Wen, Liu Lu, Wang Chunyue, Mohammed Ayman A, Yin Guoqing, Lv Xian, Xu Yawei, Che Wenliang
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
ESC Heart Fail. 2024 Dec;11(6):3934-3945. doi: 10.1002/ehf2.14977. Epub 2024 Jul 24.
The fibrosis-4 index (FIB-4) is a non-invasive tool to assess fibrosis risk in chronic liver disease. We aimed to explore the relationship between the FIB-4 index and long-term major adverse cardiovascular events (MACE) in HCM patients.
Consecutive patients diagnosed with HCM were included. Patients were divided into two groups using a defined cutoff value established through a ROC analysis for predicting MACE (FIB-4 ≥ 2.37 and FIB-4 < 2.37). The final analysis comprised 187 HCM patients (34.8% females, 66.49 ± 11.43 years of age), with 47 (25.1%) in the FIB-4 ≥ 2.37 group and 140 (74.9%) in the FIB-4 < 2.37 group. Among these, 147 (78.6%) individuals had complete follow-up data. Patients with FIB-4 ≥ 2.37 demonstrated a higher prevalence of co-morbidities such as atrial fibrillation (27.7% vs. 7.9%; P < 0.001), heart failure (55.3% vs. 24.3%; P < 0.001), elevated NT-proBNP levels (3.03 ± 4.74 vs. 0.66 ± 1.08; P < 0.001), and lower LVEF (58.51 ± 7.86 vs. 61.84 ± 5.04; P = 0.001). Over a median of 41 (IQR 16-63) months follow-up, MACE occurred in 49 (33.3%), with a significantly higher incidence in the FIB-4 ≥ 2.37 group (58.8% vs. 25.7%, P < 0.001). Cardiac death rates were also elevated in the FIB-4 ≥ 2.37 group (20.6% vs. 2.7%, P = 0.001). Cox regression analysis revealed an independent association between FIB-4 ≥ 2.37 and a higher risk of MACE (adjusted HR: 1.919, 95% CI 1.015-3.630; P = 0.045) and cardiac death (adjusted HR: 9.518, 95% CI 1.718-52.732; P = 0.010). Furthermore, the FIB-4 index shows positive correlations with left atrium diameter (r = 0.229; P = 0.003), septal thickness (r = 0.231; P = 0.002), posterior wall thickness (r = 0.235; P = 0.001), and NT-proBNP (r = 0.271; P < 0.001). Conversely, a negative correlation was observed between the FIB-4 index and left ventricular ejection fraction (r = -0.185; P = 0.011).
Elevated FIB-4 index, indicative of liver fibrosis, is independently associated with an increased risk of long-term MACE in HCM patients. This emphasizes the potential influence of liver function abnormalities on HCM prognosis, underscoring the need for comprehensive risk assessment in clinical management.
纤维化-4指数（FIB-4）是评估慢性肝病纤维化风险的一种非侵入性工具。我们旨在探讨肥厚型心肌病（HCM）患者中FIB-4指数与长期主要不良心血管事件（MACE）之间的关系。
纳入连续诊断为HCM的患者。通过预测MACE的ROC分析确定的临界值将患者分为两组（FIB-4≥2.37和FIB-4＜2.37）。最终分析包括187例HCM患者（女性占34.8%，年龄66.49±11.43岁），FIB-4≥2.37组47例（25.1%），FIB-4＜2.37组140例（74.9%）。其中，147例（78.6%）个体有完整的随访数据。FIB-4≥2.37的患者合并症患病率较高，如心房颤动（27.7%对7.9%；P＜0.001）、心力衰竭（55.3%对24.3%；P＜0.001）、NT-proBNP水平升高（3.03±4.74对0.66±1.08；P＜0.001）以及左心室射血分数较低（58.51±7.86对61.84±5.04；P = 0.001）。在中位41（四分位间距16 - 63）个月的随访中，49例（33.3%）发生MACE，FIB-4≥2.37组的发生率显著更高（58.8%对25.7%，P＜0.001）。FIB-4≥2.37组的心脏死亡率也升高（20.6%对2.7%，P = 0.001）。Cox回归分析显示FIB-4≥2.37与MACE风险较高（调整后HR：1.919，95%CI 1.015 - 3.630；P = 0.045）和心脏死亡（调整后HR：9.518，95%CI 1.718 - 52.732；P = 0.010）独立相关。此外，FIB-4指数与左心房直径（r = 0.229；P = 0.003）、室间隔厚度（r = 0.231；P = 0.002）、后壁厚度（r = 0.235；P = 0.001）和NT-proBNP（r = 0.271；P＜0.001）呈正相关。相反，FIB-4指数与左心室射血分数呈负相关（r = -0.185；P = 0.011）。
FIB-4指数升高提示肝纤维化，与HCM患者长期MACE风险增加独立相关。这强调了肝功能异常对HCM预后的潜在影响，突出了临床管理中进行全面风险评估的必要性。
