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Guan L, Li L, Zou Y, Zhong J, Qiu L. Association between FIB-4, all-cause mortality, cardiovascular mortality, and cardiovascular disease risk among diabetic individuals: NHANES 1999-2008. Front Cardiovasc Med 2023; 10:1172178. [PMID: 37817864 PMCID: PMC10560879 DOI: 10.3389/fcvm.2023.1172178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background Diabetes is prevalent worldwide and is associated with cardiovascular disease (CVD). Furthermore, due to the insulin resistance, diabetic populations are vulnerable to liver fibrosis, which increases the risk of CVD. Fibrosis-4 index (FIB-4)-a non-invasive biomarker for liver fibrosis-is crucial in predicting CVD among patients with liver diseases. However, the association between FIB-4, death, and CVD in the US diabetic population has not yet been investigated. Method We conducted a cross-sectional study using the data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008. The mortality status was obtained from the National Death Index through December 31, 2015. Participants were divided into survivor and mortality group to compare the basic characteristics. The association between FIB-4, death, and CVD was analyzed using the restricted cubic spline method and Cox proportional hazards models. In stratified analysis, Participants were stratified based on age, sex, BMI, hypertension, or eGFR respectively. Results The participants (N = 3,471) were divided into survivor (N = 1,785) and mortality groups (N = 1,632), with the mortality group exhibiting significantly higher FIB-4 values. Moreover, the risk of all-cause mortality (HR 1.24; 95% CI, 1.17-1.32) and CVD mortality (HR 1.17; 95% CI, 1.04-1.31) increased with each FIB-4 SD increase after adjusting for all covariates. However, except for myocardial infarction, FIB-4 had no significant effect on the incidence of the other three CVD subtypes (congestive heart failure, coronary heart disease, and angina pectoris). In stratified analysis, we found that the effect of FIB-4 on CVD mortality was influenced by age, and FIB-4 is a risk factor for people older than 60 years (HR 1.14; 95% CI, 1.01-1.29). Conclusion Using data from NHANES 1999-2008, FIB-4 was found to be associated with all-cause and CVD mortality in the diabetic population, and this association was significantly affected by age. However, FIB-4 only affected the incidence of myocardial infarction. Future work should investigate the association between FIB-4 and CVD in the diabetic population.
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Affiliation(s)
- Lihua Guan
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Lei Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Jian Zhong
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
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2
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Tseng CH, Huang WM, Yu WC, Cheng HM, Chang HC, Hsu PF, Chiang CE, Chen CH, Sung SH. The fibrosis-4 score is associated with long-term mortality in different phenotypes of acute heart failure. Eur J Clin Invest 2022; 52:e13856. [PMID: 35975623 DOI: 10.1111/eci.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fibrosis-4 score (FIB4) was a non-invasive surrogate to estimate the amount of liver scarring in chronic hepatitis. Considering the presence of increased central venous pressure and congestive hepatopathy in patients with decompensated heart failure, we therefore investigated the prognostic values of FIB4 in acute heart failure (AHF) patients. METHOD Patients hospitalised primarily for HF were drawn from an intramural registry. FIB4 was calculated according to age, aspartate aminotransferase, alanine aminotransferase and platelet count. All-cause mortality up to 5 years after discharge was obtained by linking to the national death registry. RESULTS Among a total of 1854 participants, 940 patients died during a mean follow-up of 28.3 ± 21.8 months. FIB4 score was related to mortality and the composite of cardiovascular death or HF rehospitalisation, independent of age, sex, left ventricular ejection fraction, left atrial dimension, sodium and haemoglobin levels, estimated glomerular filtration rate, comorbidities, and medications [hazard ratio and 95% confidence interval of mortality: 1.009 (1.002-1.015), and the composite of cardiovascular death or HF hospitalisation: 1.020 (1.010-1.031)]. The prognostic value of FIB4 was predominantly in the subjects with heart failure and preserved or mildly reduced ejection fraction (HFpEF and HFmrEF), or coronary artery disease (CAD) than the counterparts [interaction p-value <0.001, and 0.004, respectively]. CONCLUSIONS FIB4 was an independent predictor of survival in AHF patients, irrespective of the phenotypes of HF. The higher predictive value of mortality of FIB4 was observed in the subjects with HFpEF, HFmrEF or CAD.
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Affiliation(s)
- Chih-Hsueh Tseng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Min Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medicine, Kinmen Hospital, Ministry of Health and Welfare, Jinhu, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Chih Chang
- Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Pai-Feng Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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3
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Imamura T, Narang N, Onoda H, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Implications of Elevated Fibrosis-4 Index in Patients Receiving Trans-Catheter Aortic Valve Replacement. J Clin Med 2021; 10:jcm10245778. [PMID: 34945074 PMCID: PMC8705603 DOI: 10.3390/jcm10245778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prognostic implication of the fibrosis-4 index, which represents the degree of hepatic injury, on patients receiving trans-catheter aortic valve replacement (TAVR) remains unknown. METHODS Patients who underwent TAVR to treat severe aortic stenosis at our institute between 2015 and 2020 were included in this retrospective study and followed for 2 years from the index discharge. The impact of the fibrosis-4 index, which was calculated using age, hepatic enzymes, and platelet count, on 2-year heart failure readmissions was investigated. RESULTS A total of 272 patients (median age 85 (82, 88) years old, 76 (28%) men) were included. The median baseline fibrosis-4 index was 2.8 (2.2, 3.7). A high fibrosis-4 index (>3.79) was associated with higher cumulative incidence of the primary endpoint (18% versus 4%, p < 0.001) and higher event rates (0.1041 versus 0.0222 events/year, p < 0.001), with an adjusted hazard ratio of 1.27 (95% confidence interval 1.04-1.54, p = 0.019). CONCLUSION an elevated fibrosis-4 index at baseline, indicating the existence of persistent hepatic congestion, was associated with incidences of heart failure following TAVR. Calculating the fibrosis-4 index before TAVR is highly encouraged for risk stratification and shared decision making.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
- Correspondence: ; Tel.: +81-76-434-2246; Fax: +81-76-434-5026
| | - Nikhil Narang
- Advocate Christ Medical Center, Chicago, IL 60453, USA;
| | - Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Shuhei Tanaka
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (H.O.); (S.T.); (R.U.); (M.S.); (N.F.); (H.U.); (K.K.)
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Saito Y, Matsumoto N, Aizawa Y, Fukamachi D, Kitano D, Toyama K, Fujito H, Sezai A, Okumura Y. Prognostic Value of Liver Stiffness Measured by Two-Dimensional Elastography in Acute Decompensated Heart Failure with Preserved Ejection Fraction. Int Heart J 2021; 62:821-828. [PMID: 34276020 DOI: 10.1536/ihj.21-025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Liver stiffness (LS) assessed by ultrasound elastography reflects right-sided filling pressure and offers additional prognostic information in patients with acute decompensated heart failure (ADHF). However, the prognostic value of LS in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the prognostic value of LS measured by two-dimensional shear wave elastography (2D-SWE) in patients with HFpEF.We prospectively enrolled 80 patients hospitalized for decompensated HFpEF between September 2019 and June 2020. Patients were categorized into three groups based on the tertile values of LS at discharge.The third tertile LS group had an older age; more advanced New York Heart Association functional class; higher total bilirubin, γ-glutamyl transferase (GGT), N-terminal pro-B type natriuretic peptide (NT pro-BNP), and Fibrosis-4 index; a larger right ventricle diastolic diameter, higher tricuspid regurgitation pressure gradient, and a larger maximal inferior vena cava diameter. During a median [interquartile range] follow-up period of 212 (82-275) days, 25 (31.2%) patients suffered composite end points (all-cause mortality and rehospitalization for worsening HF). The third tertile LS group had a significantly higher rate of composite end points (log-rank P = 0.002). A higher LS and the third tertile LS were significantly associated with the composite end points, even after adjusting for a conventional validated HF risk score and other previously reported prognostic risk factors.Increased LS measured by 2D-SWE reflects the severity of liver impairment by liver congestion and fibrosis, underlying right HF, and provides additional information for the prediction of poor outcomes in HFpEF.
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Affiliation(s)
- Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine
| | - Yoshihiro Aizawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kazuto Toyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Kawahira M, Tamaki S, Yamada T, Watanabe T, Morita T, Furukawa Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Kimura T, Ueda K, Sakamoto D, Kogame T, Ito S, Chang Y, Fukunami M. Prognostic value of impaired hepato-renal function and liver fibrosis in patients admitted for acute heart failure. ESC Heart Fail 2021; 8:1274-1283. [PMID: 33472273 PMCID: PMC8006618 DOI: 10.1002/ehf2.13195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiohepatic interactions have been a focus of attention in heart failure (HF). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score has been shown to be useful for predicting poor outcomes in patients with acute decompensated HF (ADHF). Furthermore, the fibrosis-4 (FIB-4) index, a simple marker to assess liver fibrosis, predicts adverse prognoses in patients with HF as well. However, there is little information available on the prognostic significance of the combination of the MELD-XI score and FIB-4 index in patients with ADHF and its association with left ventricular ejection fraction (LVEF) subgroup. METHODS AND RESULTS We prospectively studied 466 consecutive patients who were admitted for ADHF [HF with reduced LVEF (LVEF < 40%): n = 164, HF with mid-range LVEF (40% ≤ LVEF < 50%): n = 104, and HF with preserved LVEF (LVEF ≥ 50%): n = 198]. We calculated the MELD-XI score and FIB-4 indices at discharge. The primary endpoint was all-cause death (ACD). During the mean follow-up period of 2.8 years, 143 patients had ACD. In the multivariate Cox analysis, the MELD-XI score and FIB-4 index were independently associated with ACD. Patients were stratified into the following three groups according to the median value of MELD-XI score (=11) and FIB-4 index (=2.13): Group 1 had both a low MELD-XI score and a low FIB-4 index; Group 2 had either a high MELD-XI score (MELD-XI score ≥11) or a high FIB-4 index (FIB-4 index ≥2.13); and Group 3 had both a high MELD-XI score and a high FIB-4 index. Kaplan-Meier analysis revealed that Group 2 and Group 3 had a significantly greater risk of ACD than Group 1 [Group 2 vs. Group 1: adjusted hazard ratio, 2.48 (95% confidence interval: 1.75-3.53), P < 0.0001; Group 3 vs. Group 1: adjusted hazard ratio, 7.03 (95% confidence interval: 3.95-13.7), P < 0.0001]. In addition, the patients with both a higher MELD-XI score and FIB-4 index showed a significantly higher risk of ACD also in the patients with HF with reduced LVEF, HF with mid-range LVEF, and HF with preserved LVEF (all P < 0.0001). CONCLUSIONS The combination of MELD-XI score and FIB-4 index may be useful for stratifying patients at risk for ACD in patients with ADHF, irrespective of LVEF.
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Affiliation(s)
- Masatsugu Kawahira
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Shunsuke Tamaki
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takahisa Yamada
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Tetsuya Watanabe
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takashi Morita
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Yoshio Furukawa
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masato Kawasaki
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Atsushi Kikuchi
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Tsutomu Kawai
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masahiro Seo
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Jun Nakamura
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Kiyomi Kayama
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takanari Kimura
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Kunpei Ueda
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Daisuke Sakamoto
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takehiro Kogame
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Shota Ito
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Yongchol Chang
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masatake Fukunami
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
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Sugimoto K, Yoshihisa A, Nakazato K, Yokokawa T, Misaka T, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Ishida T, Takeishi Y. Significance of Pulmonary Vascular Resistance and Diastolic Pressure Gradient on the New Definition of Combined Post-Capillary Pulmonary Hypertension. Int Heart J 2020; 61:301-307. [DOI: 10.1536/ihj.19-476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Koichi Sugimoto
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Pulmonary Hypertension, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Pulmonary Hypertension, Fukushima Medical University
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University
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