ABSTRACT
Objective:To investigate the prevalence and prognosis of non-alcoholic fatty liver disease (NAFLD) complicated with coronary vulnerable plaque (VP).Method:Consecutive patients were included who had undergone coronary artery CT angiography (CCTA) from January 1, 2011 to January 30, 2015 at the First People′s Hospital of Neijiang. NAFLD was diagnosed according to the liver imaging findings (liver/spleen CT ratio≤1.0) and clinical data. Baseline data, diagnosis, vulnerable plaque were recorded and followed up. The end points included all-cause death rate, cardiac death rate, non-fatal myocardial infarction rate, and elective coronary revascularization rate.Result:A total of 1 069 patients were eventually recruited in this study, including 316 (29.6%) cases diagnosed as NAFLD. In patients with NAFLD, 130 (41.1%) cases had vulnerable plaque, which was significantly higher than 217 of 753 non-NAFLD patients (28.8%) ( P<0.01). The percentages of spotty calcification, low attenuation plaque, positive remodeling and napkin ring sign in NAFLD cohort were 36.5%, 14.2%, 17.6% and 6.8% respectively, while those corresponding in non-NAFLD cohort were 18.4%, 6.3%, 5.8% and 3.2% respectively. The proportion of each vulnerable feature in NAFLD cohort was significantly higher than that in the non-NAFLD cohort, with P values of 0.016, 0.028, 0.019 and 0.042, respectively. The cardiac mortality rate in NAFLD group was significantly higher than and that of non-NAFLD group (7.0% vs. 3.6%, P=0.044). Multivariate Cox analysis suggested that NAFLD was not an independent risk factor for cardiac death. NAFLD subgroup ( n=316) was divided into VP positive group (NAFLD+VP+, n=130) and VP negative group (NAFLD+VP-, n=186). The mean follow-up time was 4.6±1.3 years. All-cause mortality rate, cardiac death rate, elective coronary artery reconstruction rate, non-fatal myocardial infarction rate in NAFLD+VP+group were 20.8%, 12.3%, 25.4%, 13.8% respectively, which were significantly higher than those corresponding rates in NAFLD+VP-group (5.9%, 3.2%, 8.6%, 6.5%) ( P<0.01, 0.002,<0.01, and 0.032 respectively). Conclusion:The incidences of cardiac mortality, elective coronary revascularization, and non-fatal myocardial infarction are significantly higher in patients with NAFLD than those without. NAFLD combined with vulnerable plaque of coronary arteries predicts worse prognosis.
ABSTRACT
Objective To investigate the risk factors for heart failure in pregnant women with heart disease. Methods A retrospective analysis was made from 340 cases of pregnant women with heart disease in our hospital from January 2008 to December 2013. The pregnant women who presented heart failure were categorized in the observation group (n=65), and others were in the control group (n=275). Data was used to analyze by univariate and multivariate logistic regression for heart failure in pregnant women with heart disease. Results The total 340 cases of heart disease included 132(38.8%) of congenital heart disease, 86(25.3%) of rheumatic heart disease, 63(18.5%) of arrhythmia, 33(9.7%) of hypertensive heart disease and 26(7.6%) of peripartum cardiomyopathy. 65 cases (65/340, 19.1%) presented with heart failure, there were 4 cases resulted in death (1.2%). Multivariate logistic regression analysis showed that age≥35, the baseline parameters of New York Heart Academy (NYHA)≥Ⅱ, pulmonary artery pressure>50 mmHg (1 mmHg=0.133 kPa), baseline heart rate>100 bpm, cardiac events occurred before pregnancy were the independent risk factors for heart failure. Prenatal counseling and antenatal examination were the protective factors for heart failure. Conclusions There are a variety of influencing factors for the heart failure in pregnant women with heart disease. It is necessary to take targeted intervention measures in response to the influencing factors so as to reduce the development of heart failure.