LIVER STEATOSIS AS A PROGNOSTIC FACTOR OF CHRONIC ISCHEMIC HEART DISEASE

Abstract

Introduction. The pandemic of metabolically associated fatty liver disease, that begins with metabolically associated hepatic steatosis (MAHS), affects the course of ischemic heart disease (IHD). According to the literature, MAHS is associated with increased calcification of coronary arteries already at the stage of steatosis, although the impact on the long-term prognosis of patients is not enough established. The aim of the study – is to determine the impact of MAHS on the long-term prognosis of patients with chronic forms of IHD. Materials and methods. For 3 years, 85 men in the age group 36-78 years old (median 57 years old) with ischemic heart disease, stable angina pectoris of I-III functional classes were observed. They were divided into two comparable groups: with MAHS (13%) and intact liver (87%). MAHS criteria: ultrasound signs of increased acoustic density of the liver compared to the kidneys, a moderate increase in the size of the liver; slight expansion of the splenic and portal veins, poor visualization of the central vessels; absence of the laboratory signs of mesenchymal inflammation activity and cytolysis (EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-alcoholic Fatty Liver Disease, 2016). Prognosis was assessed by Kaplan-Meier with determination of significance by the Cox test or Gehan-Wilcoxon test, the composite end point was an acute cardiovascular event. Results. In patients with chronic forms of ischemic heart disease, the presence of metabolically associated steatosis of the liver is an independent predictor of the development of acute cardiovascular events within three years. Unfavorable predictors of 3-year survival in patients with chronic forms of IHD were also low cholesterol - high-density lipoproteins content (<1,0 mmol/l) and increased levels of triglycerides (≥1,7 mmol/l), total fibrinogen (> 4 g/l) and soluble fibrin monomer complexes (≥ 4 mg/dL). Conclusion. Unfavorable prognostic factors for the long-term prognosis in patients with IHD were the presence of hepatic steatosis, lipid disorders, and hypercoagulation.