The impact of non-alcoholic fatty liver disease fibrosis score on cardiac prognosis in patients with chronic heart failure

Abstract

Liver abnormalities have a strong impact on clinical outcomes in patients with heart failure (HF), and are known as cardio-hepatic syndrome. The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been developed to identify liver fibrosis in patients with NAFLD. It remains to be determined whether NFS is associated with cardiovascular prognosis in patients with chronic heart failure (CHF). We calculated NFS in 516 patients with CHF admitted to our hospital. The clinical endpoints were deaths due to progressive HF, myocardial infarction, stroke, and sudden cardiac death, and rehospitalization for worsening HF. There were 173 cardiovascular events noted during a median follow-up of 464 days. Patients with cardiovascular events showed a higher NFS as compared with those without. We divided the patients into four groups according to quartiles of NFS. The proportion of New York Heart Association functional class III/IV and serum brain natriuretic peptide levels were increased with increasing NFS. Kaplan-Meier analysis revealed that cardiovascular event rate was increased with increasing NFS in patients with CHF. In multivariate Cox proportional hazards analysis, NFS was independently associated with cardiovascular events after adjustment for confounding factors. Elevated NFS was associated with unfavorable outcomes in patients with CHF. Liver fibrosis assessed by NFS may provide valuable prognostic information in patients with CHF.

Western Diet-Fed, Aortic-Banded Ossabaw Swine

“…Increased plasma liver enzyme levels and nonalcoholic fatty liver disease (Figures 6H to 6J) (evident by the combination of liver steatosis, inflammation, and fibrosis) in WD-AB animals was also consistent with nonalcoholic steatohepatitis as shown previously in WD-fed Ossabaw swine by our laboratory (14). Several reports indicate nonalcoholic steatohepatitis is related to HF and LV diastolic dysfunction 59, 60, 61, 62, 63. Further exploration of group differences that examined metabolic and renal disease, including immune and inflammation-related signaling pathways and phenotypes, were assessed using RNA-seq in LV tissue and is presented in Supplemental Figures 7 and 8 and Supplemental Tables 1 to 3.…”

Higher fatty liver index is associated with increased risk of new onset heart failure in healthy adults: a nationwide population-based study in Korea

“…Inflammatory mediators also affect the progression of fatty liver disease via impaired fatty acid oxidation, increased oxidative stress, and local inflammation [30]. The presence of NAFLD was associated with poor prognosis of chronic HF [31] and acute HF [32]. Although mechanisms of the association between NAFLD and poor clinical outcomes of HF remains unclear, there are several proposed explanations including increased coronary atherosclerosis, enhancing LV hypertrophy and dysfunction, and increased aortic valve calcification [33][34][35].…”

Higher fatty liver index is associated with increased risk of new onset heart failure in healthy adults: A nationwide population-based study in Korea

“…NAFLD was associated with poor prognosis in chronic and acute HF patients [31,32]. Although the exact mechanism of this remains unclear, there are several proposed explanations; increased coronary atherosclerosis, LV hypertrophy and dysfunction, and aortic valve calcification [33][34][35].…”