Relationship between the prevalence and severity of non-alcoholic fatty liver disease and coronary artery disease: Findings from a cross-sectional study of a referral center in northeast Iran.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent worldwide, and cardiovascular diseases are the most common cause of death in NAFLD patients. The present study aimed to evaluate the possible relationship between the presence and severity of NAFLD and coronary artery disease (CAD). Methods: A cross-sectional study was conducted on 296 patients (122 men and 174 women, with mean age 54.10 ± 9.33 years) referred to the catheterization laboratory of Imam Reza Hospital affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran, for elective coronary angiography to investigate the presence and severity of CAD. Additionally, all patients underwent abdominal ultrasonography (USG) to detect NAFLD and its severity. Results: Among the 296 patients, 187 (63.2%) had CAD and 160 (50.1%) had NAFLD. NAFLD patients had significantly higher prevalence of obesity (odds ratio [OR] = 1.047, 95% confidence interval [CI] = 1.002-1.094), hypertension (OR = 1.909, 95% CI = 1.027-3.55), hyperlipidemia (OR = 3.474, 95% CI = 1.862-6.482), and CAD (OR = 2.009, 95% CI = 1.100-3.669). The percentage of patients with normal vessels was higher in the non-NAFLD group, followed by the group with mild and severe NAFLD (P < 0.001). However, single- and multi-vessel disease incidences among the non-NAFLD, mild, and severe NAFLD groups were 36.1, 43.1, and 63.7%, respectively. Interestingly, the percentage of patients with two-vessel stenosis was significantly higher in severe NAFLD patients than mild and non-NAFLD patients (P < 0.001). Conclusion: The prevalence and severity of NAFLD were independently associated with CAD. Mild NAFLD was primarily observed among patients with normal and non-obstructive coronary artery patients, while severe NAFLD was more frequent in extensive CAD patients with multi-vessel disease.

Giant cardiac hydatid cyst with rare adhesions.

We present a 29-year-old woman who was admitted to the emergency department with shortness of breath. Using echocardiography, a giant multi-cystic mass was detected in the right ventricle, attached to the septal leaflet of the tricuspid valve and basal portion of the interventricular septum. Serologic tests (hydatid cyst antibody) confirmed Echinococcus infection. Lung computed tomography with intravenous contrast showed involvement of the pulmonary vasculature. The patient underwent cardiac surgery and the large cardiac cyst and the one in the right pulmonary artery branch were both removed. The tricuspid valve was also replaced by a bioprosthetic one. Albendazole was started preoperatively and was continued for six months after surgery. The patient recovered uneventfully and was followed up for one year. This is a report of a rare case of a very large cardiac hydatid cyst complicated by pulmonary embolism with attachments to both the tricuspid valve and interventricular septum.

Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography.

AIMS: Performing simultaneous renal angiography in patients undergoing coronary angiography for suspected coronary artery disease (CAD) is suitable for those who have a high probability for renal artery stenosis (RAS), thus better recognition of all potential candidates could have paramount importance. METHODS AND RESULTS: In a cross sectional study, 260 consecutive hypertensive and/or diabetic patients (135 males, 125 females with average age of 57.1 and 57.2 years respectively) underwent simultaneous coronary and renal angiography. RAS was identified in 55 patients (21.2%). Significant RAS (> 50%) was present in 37 patients (14.2%). Female sex (P=0.01), older age (62.1+/-10 vs 56.3+/-8.9 years, p=0.001), higher serum creatinine level (1.3+/-0.69 vs 0.98+/-0.35 mg/dl p=0.017), reduced estimated glomerular filtration rate (eGFR) (58.6+/-25.4 vs 81.8+/-28.1 ml/min/1.73 m2, p< 0.001), increased levels of intra-arterial systolic blood pressure (169.8+/-31.1 vs 155.1+/-28.4 mmHg, p=0.004) and pulse pressure (90.9+/-26.2 vs 77.5+/-21.9, p=<0.001) during catheterisation, history of hypertension alone (p=0.007) or accompanied with diabetes mellitus (DM) (p=0.014) and multi vessel CAD (> 2 vessels, p=0.002) were associated with significant RAS in univariate analysis and normal coronary arteries was a strong negative predictive factor (negative predictive value=95%). There was no significant relationship between involved location of coronary arteries, history of DM alone, history of dyslipidaemia and smoking with RAS. In multivariate model, female sex [odds ratio (OR) 0.3; 95% confidence interval (CI) 0.12-0.80, P=0.016], multivessel CAD (OR 1.88; 95% CI 1.25-2.83, P=0.002) and reduced eGFR (OR 0.96; 95% CI 0.95-0.99, P=0.002) were independent predictors of RAS. CONCLUSIONS: Considering the limitations of non-invasive techniques, it seems worthwhile from both diagnostic and prognostic standpoints to perform simultaneous renal angiography following coronary angiography in patients with multivessel CAD, especially if other mentioned risk predictors are also present.