Summary
Background/aim
The relationship between nonalcoholic fatty liver disease (NAFLD) and coronary heart disease (CHD) is poorly understood. In the present study, we aimed to assess the frequency of NAFLD in CHD patients by using a new diagnostic tool: transient elastography (TE; Fibroscan®-CAP). Clarification of the present study may help to provide a new noninvasive tool for the assessment of NAFLD in this specific population of patients and may be of clinical importance in planning preventive strategies in high-risk patients.
Patients and methods
A total of 75 patients with proven CHD were enrolled. Liver stiffness was used to assess liver fibrosis, and controlled attenuation parameter (CAP) was used to detect and quantify liver steatosis by using Fibroscan® (Echosens, Paris, France). By CAP being implemented on TE, both liver steatosis and fibrosis can be evaluated simultaneously.
Results
Of the 75 patients, 45 (60 %) had CAP > 238 dBm−1 and, by definition, NAFLD. Among the patients with NAFLD, 24 (53.3 %) had, in addition, liver stiffness > 7 kPa. Analyzing the influence of the degree of liver steatosis (expressed by CAP values) on the degree of CHD (defined by single or multiple vessels involved), we found that patients with multiple vessels involved had higher CAP values (p = 0.002). Furthermore, we noticed that significantly more patients with multiple vessels involved had liver stiffness > 7 kPa (p < 0.0001) indicating the more severe form of NAFLD in those patients.
Conclusion
The main finding of our study is that TE provides the opportunity of noninvasive screening for NAFLD in CHD patients, as it is a quick, simple, reliable, and repeatable method and more cost-effective than liver biopsy.
Zusammenfassung
Hintergrund/Ziel der Studie
Der Zusammenhang zwischen der NAFLD und der CHD ist unklar. In der vorliegenden Studie wollten wir die Häufigkeit einer NAFLD bei Patienten mit einer CHD unter Verwendung eines neuen diagnostischen Gerätes (TE – Transiente Elastographie; Fibroscan®- CAP) erheben. Die Ergebnisse unserer Studie könnten helfen, ein neues nicht-invasives Gerät zur Erfassung einer NAFLD bei dieser besonderen Patientenpopulation einzusetzen. Der klinische Nutzen könnte in der darauf basierenden Planung einer präventiven Strategie bei Hochrisikopatienten liegen.
Patienten und Methodik
Es wurden 75 Patienten mit nachgewiesener CHD in die Studie aufgenommen. Die Steifheit der Leber wurde zur Beurteilung einer möglichen Leberfibrose herangezogen. Der „Controlled Attenuation Parameter (CAP)“ wurde mit Hilfe eines Fibroscan® (Echosens, Paris, Frankreich) erhoben und zur Erkennung und Quantifizierung einer möglichen Lebersteatose eingesetzt. Durch die Einbeziehung der CAP in die TE kann sowohl die Steatose als auch die Fibrose der Leber beurteilt werden.
Ergebnisse
Von den 75 Patienten hatten 45 (= 60 %) ein CAP > 238 dBm−1 und damit per definitionem eine NAFLD. Von diesen Patienten mit NAFLD hatten 24 (= 53,3 %) eine Lebersteife > 7 kPa.Die Analyse eines möglichen Zusammenhangs zwischen dem Grad der Lebersteatose (ausgedrückt in CAP Werten) mit dem Schweregrad der CHD (definiert durch die Anzahl der befallenen Gefäße) ergab, dass Patienten mit einer Mehrgefäßerkrankung höhere CAP Werte (p = 0,002) aufwiesen. Auch eine Lebersteife > 7 kPa wurde bei diesen Patienten mit Mehrgefäßbefall signifikant häufiger erhoben.
Schlussfolgerung
Unsere Studie zeigt, dass die TE die Möglichkeit eines nicht-invasiven Screenings auf NAFLD bei CHD Patienten bietet. Die Methode ist ein rasches, einfaches, verlässliches und reproduzierbares Verfahren, – kosteneffizienter als eine Leberbiopsie.
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Mikolasevic, I., Orlic, L., Milic, S. et al. Nonalcoholic fatty liver disease (NAFLD) proven by transient elastography in patients with coronary heart disease. Wien Klin Wochenschr 126, 474–479 (2014). https://doi.org/10.1007/s00508-014-0538-0
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DOI: https://doi.org/10.1007/s00508-014-0538-0