Significant Association Between Left Ventricular Diastolic Dysfunction, Left Atrial Performance and Liver Stiffness in Patients with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease

PURPOSE

The constitutive elements of the metabolic syndrome (MetS) are linked with both non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. Controlled attenuation parameter (CAP), and vibration controlled transient elastography (VCTE), are able to detect and quantify NAFLD, while conventional and two-dimensional speckle tracking echocardiography (2D-STE) is capable to identify subclinical changes in cardiac function. We wanted to evaluate whether there is any correspondence between left ventricular (LV) diastolic dysfunction and different degrees of liver steatosis and fibrosis in MetS subjects with NAFLD.

PATIENTS AND METHODS

A total of 150 adult subjects having MetS and a normal left ventricular (LV) systolic function were recorded in the study, while 150 age- and sex- matched adults without MetS were enrolled as controls. NAFLD was established by VCTE and CAP. The left heart systolic and diastolic function was evaluated by conventional and 2D-ST echocardiography. Left atrial (LA) stiffness was calculated as the ratio between the E/A ratio and the LA reservoir-strain.

RESULTS

In univariate regression analysis, the variables associated with LV diastolic dysfunction in MetS patients were: liver steatosis grade ≥2, liver fibrosis grade ≥2, the longitudinal LA peak strain during the reservoir phase, the LA strain rate during ventricular contraction and the LA stiffness. In multivariate logistic regression, two variables were selected as independent predictors of LV diastolic dysfunction, namely the liver stiffness (P=0.0003) and the LA stiffness (P<0.0001). LA stiffness predicted subclinical LV diastolic dysfunction in MetS patients with a sensitivity of 45% and a specificity of 96% when using a cut-off value >0.38, and was significantly correlated with liver steatosis stage ≥2 and liver fibrosis stage ≥2.

CONCLUSION

The present study confirms the association between liver stiffness, LA stiffness and LV diastolic dysfunction in MetS patients. Our study suggests that liver elastography and 2D-STE should become habitual assessments in MetS patients.

Independent predictors of in-hospital and 1-year mortality rates in octogenarians with acute myocardial infarction

Older age is known as a negative prognostic parameter in acute myocardial infarction (AMI) patients. In this study, we aimed to explore age-associated differences in treatment protocols, in-hospital and 1-year mortality. This cohort observational study included 277 consecutive AMI patients, separated into 2 groups according to whether their age was ≥80 years or not. We found that group I patients (aged ≥80 years) had a notably lower rate of percutaneous coronary intervention (PCI) performed (P < 0.0001) and a notably higher in-hospital death rate (P < 0.003). The multivariate logistic regression analysis found that three variables were independent predictors of in-hospital mortality: age ≥80 years (P < 0.0001), LVEF <40% (P < 0.0001), and Killip class ≥3 (P < 0.0001). The 1-year death rate was again significantly higher in group I patients (P < 0.001) and was independently predicted by the triple-vessel coronary artery disease (P = 0.004) and an LVEF <40% at admission (P = 0.001). The 1-year readmission rate was superior in group I (P < 0.01) and independently predicted by an age ≥80 years (P < 0.001), and an history of congestive heart failure (P < 0.0001) or permanent atrial fibrillation (P < 0.001). We concluded that patients aged ≥80 benefit less often from a PCI and have higher rates of in-hospital mortality, as well as of 1-year readmission and mortality rates.

The Prognostic Role of Anemia in Heart Failure Patients

Anemia is frequently observed in heart failure (HF) patients. The aim of this prospective study was to assess if it is an independent predictor of outcome or a marker of a worse clinical condition in these patients. The study included 134 heart failure patients aged over 18 years. The patients were divided into two groups, according to the presence or absence of anemia at hospital admission. Anemia was defined as a hemoglobin concentration of less than 12 g/dl for women and less than 13 g/dl for men. The endpoints were: length of hospitalization, all cause-death during hospitalization, and all-cause death and HF rehospitalizations at 1 year. Anemia occurred in 33% of HF patients. The HF patients with anemia were significantly older, had more often ischemic etiology of heart failure and atrial fibrillation, chronic kidney disease and 3 or more comorbidities. The length of hospitalization was similar between the two groups. Deaths during hospitalization occurred in 13% of anemic and in 3% of the nonanemic patients (P=0.04). During the 1- year follow-up, 45% of the anemic vs. 28% of the nonanemic patients were rehospitalized due to aggravated HF (P=0.04), and 14% of the anemic vs 20% of the nonanemic patients died (P=0.38). Anemia was strongly predictive for in-hospital and 1- year all-cause deaths in univariate analysis, but not in multivariate analysis. Anemia seems more a marker of a worse clinical condition, rather than an independent risk factor in HF.