E.V. KHAZOVA^{1, 2}, D.O. SUBKHANGULOVA¹, O.V. BULASHOVA¹

 ¹Kazan State Medical University, Kazan

²Kazan (Volga) Federal University, Kazan

  Contact details:

Khazova E.V. — Ph. D. (Medicine), Associate Professor of the Department of Propedeutics to Internal Diseases named after Prof. S.S. Zimnitsky, researcher of the UNIL «New Professional Competences in Health Preservation»

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-905-313-97-10, e-mail: hazova_elena@mail.ru

Non-alcoholic fatty liver disease (NAFLD) and chronic heart failure (CHF) are characterized by a high and constantly increasing prevalence. Hepatocardial relationships in patients with CHF are based on impaired blood supply and hypoxia.

The purpose — to investigate liver damage in patients with CHF using the HSI index.

Material and methods. 348 patients with stable CHF in the compensation stage, aged 66.4 (10.4) years, were examined. Liver damage was assessed by the HSI index.

Results and conclusions. NAFLD was detected in 54.3% of patients with CHF. The proportion of people with NAFLD decreased with increasing age: 62.8% in the group of < 60 years, 53.6% — 60–75 years, 45.1% — > 75 years. Patients with CHF and NAFLD were more often female (p = 0.002), younger (p = 0.001), with burdened heredity for cardiovascular diseases (p = 0.010), with type 2 diabetes mellitus (p < 0.001). The proportion of patients with CHF IV FC was higher in the presence of NAFLD (p = 0.03). Patients with NAFLD had higher body mass index (BMI) (p<0.001) and metabolic index (p < 0.001). Obesity of 1–3 degrees was more often in patients with NAFLD than without liver damage (p < 0.001). The mass of the left ventricular myocardium (MMLF) in male and female patients with CHF was higher in the presence of NAFLD, compared with patients without NAFLD (p = 0.004 and p = 0.001). A comparison of blood parameters in patients with CHF and NAFLD demonstrated a higher level of glucose (p < 0.001), alanine aminotransferases (ALT) (p < 0.001), uric acid (p = 0.013), total protein (p = 0.013), highly sensitive C-reactive protein (hs-CRP) (p = 0.012) and triglycerides (TG) (p < 0.001). Correlations of HSI with age, BMI, metabolic index, glucose levels, ALT, uric acid, total protein, hs-CRP, total cholesterol, triglycerides, and MMLF were revealed.

Key words: non-alcoholic fatty liver disease, chronic heart failure, HSI index.

REFERENCES

1. Mc Donagh T.A., Metra M., Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, vol. 42 (36), pp. 3599–3726. DOI: 10.1093/eurheartj/ehab368
2. Younossi Z.M., Golabi P., Paik J.M. et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology, 2023, vol. 77 (4), pp. 1335–1347. DOI: 10.1097/HEP.0000000000000004
3. Rinella M.E., Neuschwander-Tetri B.A., Siddiqui M.S. et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 2023, vol. 77 (5), pp. 1797–1835. DOI: 10.1097/HEP.0000000000000323
4. Lazebnik L.B., Radchenko V.G., Golovanova E.V. et al. Non-alcoholic fatty liver disease: clinical picture, diagnosis, treatment (recommendations for therapists, 2nd version). Terapiya, 2017, vol. 3, no.13, pp. 6–23 (in Russ.).
5. Eslam M., Newsome P.N., Sarin S.K. et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol, 2020, vol. 73 (1), pp. 202–209. DOI: 10.1016/j.jhep.2020.03.039
6. Nguyen V.H., Le M.H., Cheung R.C., Nguyen M.H. Differential clinical characteristics and mortality outcomes in persons with NAFLD and/or MAFLD. Clin Gastroenterol Hepatol, 2021, vol. 19 (10), pp. 2172–2181.e6. DOI: 10.1016/j.cgh.2021.05.029
7. Zhang H.J., Wang Y.Y., Chen C. et al. Cardiovascular and renal burdens of metabolic associated fatty liver disease from serial US national surveys, 1999–2016. Chin Med J (Engl), 2021, vol. 134 (13), pp. 1593–1601. DOI: 10.1097/CM9.0000000000001513
8. Ivashkin V.T., Maevskaya M.V., Zharkova M.S. et al. Clinical recommendations of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the Russian Association of Endocrinologists, the Russian Association of Gerontologists and Geriatricians and the National Society of Preventive Cardiology for diagnosis and treatment of non-alcoholic fatty liver disease. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii, 2022, vol. 32, no. 4, pp. 104–140 (in Russ.).
9. Ivashkin V.T., Zharkova M.S., Korochanskaya N.V. et al. Phenotypes of non-alcoholic fatty liver disease in various regions of the Russian Federation, diagnostic and therapeutic approaches in clinical practice. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii, 2023, vol. 33, no. 2 (in Russ.), p. 1. DOI: 10.22416/1382-4376-2023-33-2-1
10. Maev I.V., Andreev D.N., Kucheryavyy Yu.A. Prevalence of non-alcoholic fatty liver disease in Russia: meta-analysis. Consilium Medicum, 2023, vol. 25, no. 5, pp. 313–319 (in Russ.). DOI: 10.26442/20751753.2023.5.202155
11. Polyakov D.S., Fomin I.V., Belenkov Yu.N. et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of observation? Results of the study EPOCHA-CHF. Kardiologiya, 2021, vol. 61, no. 4, pp. 4–14 (in Russ.).
12. Mareev V.Yu., Fomin I.V., Ageev F.T. et al. Clinical recommendations OSSN — RKO — RNMOT. Heart failure: chronic (CHF) and acute decompensated (ADHF). diagnosis, prevention and treatment. Kardiologiya, 2018, vol. 58, no. 6S, pp. 8–158 (in Russ.).
13. Adams L.A., Anstee Q.M., Tilg H., Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut, 2017, vol. 66 (6), pp. 1138–1153. DOI: 10.1136/gutjnl-2017–313884
14. Anstee Q.M., Mantovani A., Tilg H., Targher G. Risk of cardiomyopathy and cardiac arrhythmias in patients with nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol, 2018, vol. 15 (7), pp. 425–439. DOI: 10.1038/s41575-018-0010-0
15. Mantovani A., Byrne C.D., Benfari G. et al. Risk of heart failure in patients with nonalcoholic fatty liver disease: JACC review topic of the week. J Am Coll Cardiol, 2022, vol. 79 (2), pp. 180–191. DOI: 10.1016/j.jacc.2021.11.007
16. Vasconcelos L., Almeida E., Bachur L. Clinical Evaluation and Hepatic Laboratory Assessment in Individuals with Congestive Heart Failure. Arq. Bras. Cardiol, 2007, vol. 88 (5), pp. 524–529.
17. Giallourakis C.C., Rosenberg P.M., Friedman L.S. The liver in heart failure. Clin Liver Dis, 2002, vol. 6 (4), pp. 947–967.
18. Allen L.A., Felker G.M., Pocock S. et al. CHARM Investigators. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur J Heart Fail, 2009, vol. 11 (2), rr. 170–177. DOI: 10.1093/eurjhf/hfn031
19. Lee H., Lee Y.H., Kim S.U., Kim H.C. Metabolic dysfunction-associated fatty liver disease and incident cardiovascular disease risk: a nationwide cohort study. Clin Gastroenterol Hepatol, 2020, vol. 19 (10), pp. 2138–2147.e10. DOI: 10.1016/j.cgh.2020.12.022
20. Targher G., Byrne C.D., Lonardo A.et al. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol, 2016, vol. 65 (3), pp. 589–600. DOI: 10.1016/j.jhep.2016.05.013
21. Wijarnpreecha K., Lou S., Panjawatanan P.et al. Association between diastolic cardiac dysfunction and nonalcoholic fatty liver disease: A systematic review and meta-analysis. Dig Liver Dis, 2018, vol. 50 (11), rr. 1166–1175. DOI: 10.1016/j.dld.2018.09.004
22. Mantovani A., Petracca G., Csermely A. et al. Non-alcoholic fatty liver disease and risk of new-onset heart failure: an updated meta-analysis of about 11 million individuals. Gut. Dis, 2023, vol. 72, pp. 372–338. DOI: 10.1136/gutjnl-2022-327672
23. Minhas A.M.K., Jain V., Maqsood M.H. et al. Non-alcoholic fatty liver disease, heart failure, and long-term mortality: insights from the national health and nutrition examination survey. Curr Probl Cardiol, 2022, vol. 47 (12), r. 101333. DOI: 10.1016/j.cpcardiol.2022.101333
24. Vovk E.I. Non-alcoholic fatty liver disease as a proatherogenic disease: diagnosis and treatment in general practice. RMZh. Meditsinskoe obozrenie, 2017, vol. 25, no. 2, pp. 68–79 (in Russ.).
25. Zhirkov I.I., Gordienko A. V., Pavlovich I.M. et al. Non-invasive methods for diagnosing steatosis in non-alcoholic fatty liver disease. Eksperimental’naya i klinicheskaya gastroenterologiya, 2020, vol. 177, no. 5, pp. 61–66 (in Russ.).
26. Charatcharoenwitthaya P., Lindor K.D., Angulo P. The spontaneous course of liver enzymes and its correlation in nonalcoholic fatty liver disease. Dig Dis Sci, 2012, vol. 57 (7), pp. 1925–1931.
27. Lee J.H., Kim D., Kim H.J. et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis, 2010, vol. 42 (7), pp. 503–508. DOI: 10.1016/j.dld.2009.08.002
28. Statsenko M.E., Turkina S.V., Kosivtsova M.A., Shilina N.N. Non-invasive diagnosis of non-alcoholic fatty liver disease: simple “tools” are already in the hands of a practitioner. Vestnik VolGMU, 2019, iss. 2 (70), pp. 134–139 (in Russ.).
29. Kukharchuk V.V., Ezhov M.V., Sergienko I.V. et al. Diagnostika i korrektsiya narusheniy lipidnogo obmena s tsel’yu profilaktiki i lecheniya ateroskleroza: Rossiyskie rekomendatsii, VII peresmotr. [Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis: Russian recommendations, VII revision]. Moscow, 2020. 61 p.
30. Misan I.A., Arisheva O.S., Garmash I.V., Kobalava Zh.D. Clinical features and prognosis of patients with decompensated heart failure and non-alcoholic fatty liver disease. Kardiovaskulyarnaya terapiya i profilaktika, 2023, vol. 22, no. S6, p. 11 (in Russ.).
31. Lonardo A., Nascimbeni F., Ballestri S. et al. Sex differences in nonalcoholic fatty liver disease: state of the art and identification of research gaps. Hepatology, 2019, vol. 70 (4), pp. 1457–1469. DOI: 10.1002/hep.30626
32. Krivosheev A.B., Kuimov A.D., Bogoryanova P.A. et al. Clinical and metabolic features of non-alcoholic fatty liver disease in men and women. Terapevticheskiy arkhiv, 2017, vol. 89 (2), pp. 45–51 (in Russ.). DOI: 10.17116/terarkh201789245-51
33. Ballestri S., Nascimbeni F., Baldelli E. et al. NAFLD as a sexual dimorphic disease: role of gender and reproductive status in the development and progression of nonalcoholic fatty liver disease and inherent cardiovascular risk. Adv Ther, 2017, vol. 34 (6), pp. 1291–1326. DOI: 10.1007/s12325-017-0556-1
34. Quek J., Chan K.E., Wong Z.Y. et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 2023, vol. 8 (1), pp. 20–30. DOI: 10.1016/S2468-1253(22)00317-X
35. Tripolino C., Irace C., Cutruzzolà A. et al. Hepatic Steatosis Index Is Associated with Type 1 Diabetes Complications. Diabetes Metab Syndr Obes, 2019, vol. 12, pp. 2405–2410.
36. Sviklāne L., Olmane E., Dzērve Z. et al. Fatty liver index and hepatic steatosis index for prediction of non-alcoholic fatty liver disease in type 1 diabetes. J Gastroenterol Hepatol, 2018, vol. 33, pp. 270–276.
37. Drapkina O.M., Zyatenkova E.V. Assessment of remodeling of the cardiovascular system and thickness of epicardial fat in patients with chronic heart failure and metabolic syndrome. Terapevticheskiy arkhiv, 2016, vol. 88, no. 2, pp. 64–70 (in Russ.).