Prevalence and Prognostic Value of Non-Alcoholic Fatty Liver Disease in Patients Hospitalized With Decompensated Chronic Heart Failure.

Aim    To study the incidence and effect of non-alcoholic fatty liver disease (NAFLD) on clinical outcomes in patients with decompensated chronic heart failure (DCHF).Material and methods    The study included 338 patients with NYHA functional class III-IV DCHF (51.2% men, mean age 72.8±11.7 years), arterial hypertension (AH) in 90%, myocardial infarction in 37%, atrial fibrillation in 64%, chronic kidney disease (CKD) in 42%, type 2 diabetes mellitus (T2DM) in 35%, left ventricular ejection fraction (LVEF) <40% in 27%. NAFLD was diagnosed based on the 2021 Clinical Guidelines of the Russian Scientific Medical Society of Therapists and the Scientific Society of Gastroenterologists of Russia. The stage of liver steatosis was determined using transient elastometry with assessment of the controlled attenuation parameter (CAP) of ultrasound (S, dB/m) using a FibroScan device. Threshold CAP values <294 dB/m corresponded to the degree of steatosis: S0; S1, 295-309 dB/m; S2, 310-330 dB/m; S3, ≥331 dB/m.Results    NAFLD was diagnosed in 28.9% of patients. The patients were divided into two groups: group 1 included patients with CHF and NAFLD (n=98 (28.9%), 50.0% men) and group 2 included patients with CHF without NAFLD (n=240 (71.0 %), 51.6% men). A multivariate regression analysis showed that independent predictors of NAFLD were systolic blood pressure ≥130 mm Hg (odds ratio (OR), 3.700; p <0.001), history of T2DM (OR, 2.807; p <0.005), and waist circumference >111 cm (OR, 2.530; p <0.012). Patients with CAP ≥331 dB/m (S3) had a worse prognosis during the 2-year follow-up for the composite adverse outcome (all-cause mortality + readmission) (Kaplan-Meier curves - Log-Rank p=0.035).Conclusions    NAFLD was detected in almost one-third of patients hospitalized for DCHF. AH, T2DM, and abdominal obesity were associated with a high risk of NAFLD. However, only severe steatosis (S3) was an independent predictor of adverse clinical outcomes during a 2-year period after adjustment for known risk factors.

Meta-Analysis of Non-Alcoholic Fatty Liver Disease and Electromechanical Reconstruction of Myocardium.

In developed countries, non-alcoholic fatty liver disease (NAFLD), which results from obesity, has become endemic and kills many adults annually. Health research centers in most countries are looking to examine the relationship between metabolic syndrome (MetS) and metabolic biomarkers. A bleeding-prone standard liver biopsy or costly magnetic resonance imaging scan is used to diagnose NAFLD. The present study aimed to analyze medical databases using various scientific articles; moreover, this experiment analyzed medical databases using published scientific articles related to NAFLD, endovascular treatment, cardiac arrhythmias and conduction disorders, changes in the geometry of atria and ventricles, changes in myocardial mass volume as well as diastolic flow left and right ventricular systolic functions, coronary blood flow, analysis of the dependence of epicardial fat tissue (EFT) thickness, and the presence of chronic heart failure (CHF). It is demonstrated that the index of EFT in NAFLD positively correlated with the criteria of cardiovascular health, values of the carotid intima-media thickness, and calcification of the coronary arteries on the coronary artery calcium scale (P<0.0001). The index of per EFT significantly correlated with the factor of the age of the NAFLD patients (P=0.04), hemoglobin A1C level (P<0.001), systemic inflammatory index (P=0.02), the index of impaired glucose tolerance (P=0.03), and especially, the patient's diabetes factor (P<0.001). In addition, adiponectin levels were significantly lower in individuals with NAFLD (P=0.001) and patients with MetS (P=0.02). NAFLD in association with an increase in epicardial adipose tissue (EAT) is an independent risk factor for atherosclerosis, coronary heart disease, CHF, as well as structural and electrophysiological myocardial remodeling. The study of pathogenetic mechanisms in the context of the role of EAT and clinical monitoring of its condition are urgent problems of modern medicine.

[Prognostic value of liver stiffness in decompensated heart failure: results of prospective observational transient elastography-based study].

OBJECTIVE: There is growing evidence that liver stiffness (LS) in decompensated heart failure (DHF) is related to congestion, however data about its impact on outcomes are limited. The aim of the study was to evaluate associations and long-term prognostic significance of LS measured by transient elastography (TE) in DHF. METHODS: Single-center prospective observational study of 194 patients hospitalized with DHF, of whom 71 % were male, 68 ± 11 years (mean ± SD), had a left ventricular ejection fraction of 39±14%. LS by TE (FibroScan 502, Echosens, France) was measured on admission (n=176) and/or discharge (n=165). Outcomes of interest were all-cause death or heart transplantation, heart failure (HF) rehospitalisation, heart valve repair surgery. Outcome analysis was performed with Kaplan-Meier survival curves compared by log-rank test and with Cox proportional hazards regression. RESULTS: Median LS on admission and discharge were 11.1 (interquartile range 6.3;22.9) and 8.2 (5.8;14.0) kPa, respectively. Higher LS was associated with more clinical congestion on admission and discharge. Patients with LS on admission ≥11.1 kPa and at discharge ≥8.2 kPa were characterised by more pronounced clinical and echocardiographic signs of right-sided HF. Total of 5 (2.6%) patients died in hospital. Further, 31 (17.3%) deaths, 1 (0.6%) heart transplantation, 3 (1.7%) valve repair surgeries and 54 (30.2%) HF rehospitalizations occurred during follow-up (median 183 days). LS ≥ median was associated with higher probability of HF rehospitalizations and composite end point (all-cause death, heart transplantation, HF rehospitalisation and valve replacement therapy) both on admission (logrank p=0.004 and p=0.006) and at discharge (log-rank p=0.001 and p=0.004). Multivariable Cox regression analysis revealed that on a continuous scale LS increase per 1 kPa on admission was related to higher risk of HF hospitalization (hazard ratio [HR] 1.024, 95% confidential interval [CI] 1.002-1.046, p=0.03). LS at discharge was independently associated with increased all-cause mortality (HR per 1 kPa increase 1.098, 95% CI 1.025-1.176, p=0.008), higher risk of HF hospitalization (HR 1.075, 95% CI 1.035-1.117, p.

[Serum markers of fibrosis and endothelial dysfunction in patients with alcoholism, with varying degrees of liver fibrosis].

In the serum of patients with alcoholism with varying degrees of severity of liver fibrosis were studied the content markers of fibrosis, endothelial dysfunction and proinflammatory cytokines. Concentration in blood indicators of fibrogenesis--collagen type 4, hyaluronic acid, TIMP-1, TIMP-2, YKL-40 and MMP-2 is considerably increased at the 4 degree of fibrosis and moderately increased at low and zero degrees of liver fibrosis. Similar results were obtained in respect of proinflammatory cytokines Il-6, IL-8, IL-12/p70 and IL-12/p40. The magnitude of endothelial dysfunc- tion, calculated based on its content in the blood markers--VEGF-A, MCP-1, s-VCAM, s-ICAM and endothelin, was maximal at 4 degrees of fibrosis and less pronounced at low degrees of fibrosis. Correlations between of the average degree of fibrosis, endothelial dysfunction, and blood levels of proinflammatory cytokines were installed. Close relation between the immune cells releasing stimulators of inflammation and fibrogenesis, perisinusoidal fat cells producing collagen, and endothelium secreting vasoconstrictors in the pathogenesis of alcoholic liver fibrosis and cirrhosis was installed.

[Polymorphism of the apolipoprotein E gene (APOE) in the populations of Russia and neighboring countries].

Allele and genotype frequencies for the locus encoding apolipoprotein E, involved in the regulation of lipid metabolism (APOE), were evaluated in 16 populations representing 12 ethnic groups (a total of 1103 subjects) from Russia and neighboring countries. In the populations examined, the frequencies of allele epsilon4, which is the risk factor of Alzheimer's disease and coronary heart disease, varied from less than 5 to more than 20%, while the variation of the major epsilon3 allele in these populations ranged from less than 75 to 95%. The frequencies of alleles epsilon3 and epsilon4 were 0.714 and 0.205 in Saami, 0.734 and 0.149 in Maris, 0.841 and 0.122 in Evenks, 0.788 and 0.163 in Buryats, 0.764 and 0.202 in Chukchi, 0.875 and 0.075 in Iranians, 0.956 and 0.044 in mountain-dwellers of the Pamirs, 0.771 and 0.094 in Ukrainians, and 0.795 and 0.091 in Belarussians, respectively. In Russians from different regions of the country, the frequencies of these alleles were 0.728 and 0.139 (Kostroma), 0.795 and 0.105 (Moscow), 0.857 and 0.092 (Rostov-on-Don), and 0.824 and 0.083 (Krasnodar), respectively. The latitudinal distribution of the APOE epsilon3 and epsilon4 allele frequencies in the populations examined was comparable to the frequency distribution pattern of these alleles in other populations of Eurasia.

[Alcohol-induced arterial hypertension and genetic polymorphism of alcohol-metabolizing enzymes].

AIM: To study arterial pressure (AP) and heart rate (HR) in patients suffering from alcohol withdrawal syndrome (AWS) with relation to genetic polymorphism of alcohol dehydrogenase-2 (ADG2) and aldehyde dehydrogenase-2 (AlDG2). MATERIAL AND METHODS: AP and HR were analysed for 36 alcoholics (83 hospitalizations, including repeated ones) with genotypes ADG2 and AIDG2 at admission to and discharge from narcological hospital. RESULTS: ADG2 genotypes distribution was the following: ADG2-1/1--61.1% (n = 22); ADG2-1/2--36.1% (n = 13); ADG2-2/2--2.8% 9n = 1). All the patients had a genotype AIDG2-1/1. A hypertensive reaction occurred in 75.9% inpatients with AWS. At admission, patients with genotype ADG2-1/1 had significantly higher systolic AP and HR vs those with allele ADG2-2: 146.6 +/- 17.0 mmHg against 141.2 +/- 14.9 mmHg, 95.6 +/- 13.9 b/min vs 88.5 +/- 12.2 b/min, respectively. In homozygous genotype ADG2-1/1 AP and HR were higher than in heterozygotes: SAP 152.3 +/- 12.9 mm Hg vs 145.2 +/- 16.2 mm Hg, pulse pressure 57.2 +/- 11.9 vs 50.0 +/- 15.1 mm Hg, HR 96.8 +/- 13.4 b/min vs 87.7 +/- 12.0 b/min. The groups had similar mean diastolic pressure. At discharge, AWS standard therapy resulted in a significant lowering of AP and HR in the study group. Mean values of the parameters in groups with different genotypes did not differe at discharge. CONCLUSION: Population of alcoholics from the Moscow Region had allele polymorphism ADG2. Genetic polymorphism AlDG2 is not typical for this group. Hypertensive reaction was registered in the majority of alcoholics in AWS. Higher systolic, pulse pressure and heart rate were significantly higher in the AWS group with genotype ADG2-1/1. Controlled alcohol withdrawal entails a significant reduction of AP and HR.