OBJECTIVE

To study hepatocardial connections in patients with arterial hypertension (AH) and non-alcoholic fatty liver disease (NAFLD), features of cardiac remodeling in comorbid patients compared with patients with isolated AH.

MATERIAL AND METHODS

A cross-sectional comparative study was conducted, which included 120 patients aged 45 to 65 years, of both sexes, with 1-2 degree AH, stage I-II (with and without NAFLD (fatty liver index (FLI) >60). Antihypertensive drugs were discontinued in all patients 5-7 days prior to randomization. During the examination, a clinical examination was carried out: analysis of the anamnesis data, assessment of the general condition, measurement of «office» blood pressure, calculation of heart rate, analysis of anthropometric parameters: height, body weight, body mass index. The structural and functional state of the liver and heart was assessed, and the indices of liver steatosis and fibrosis were calculated.

RESULTS

When assessing the main clinical and demographic indicators, the comparison groups are comparable. When assessing the functional state of the liver, statistically significant higher levels of gamma-glutamyl transpeptidase (GGTP) (p=0.001) and alkaline phosphatase (AP) (p=0.002) were found in patients with comorbid pathology compared with patients with hypertension without concomitant NAFLD. An echocardiographic study showed that in patients with hypertension and NAFLD, there were statistically significantly higher indicators reflecting left ventricular (LV) myocardial hypertrophy (the thickness of the posterior wall of the left ventricle (PVLV) (p=0.019), the thickness of the interventricular septum (IVS) (p=0.012). LV myocardial mass (LVML) (p=0.029) Based on the value of the LVML index, it was determined that in patients with AH and NAFLD, left ventricular hypertrophy was diagnosed more often, but not statistically significant (in 81.7% compared with 68.3% of cases (p=0.139) When analyzing the types of LV remodeling, it was found that in patients with AH and NAFLD, concentric LV hypertrophy was detected statistically significantly more often than in patients with isolated AH (75.0% compared with 55.0%, respectively). When conducting a correlation analysis in patients of the AH and NAFLD group, statistically significant hepatocardial relationships were revealed: the FLI index directly correlated with LVML (r=0.3, p=0.001), LVL VA (r=0.3, p=0.001), IVS thickness (r=0.3, p=0.001) and isovolumic relaxation time from from the moment of closing of the aortic valve to the moment of opening of the mitral valve (IVRT) (r=0.25, p=0.005). Based on the results of the logistic analysis, the covariates of alanine aminotransferase (AlAT), ALP, GGTP, and FLI have a direct relationship, and aspartate aminotransferase (AcAT) have an inverse relationship with the risk of pathological cardiac remodeling. Based on the functional state of the liver, it can be concluded that with an increase in the level of ALT by 1 U/l, the risk of an increase in the relative thickness of the LV wall (more than 42%) increased by 15.7% (95% CI 1.09-1.20%, p=0.004), and the formation of concentric LV hypertrophy — by 1.2% (95% CI 1.01-1.03%, p=0.004). An increase in ALP activity by 1 U/l increased the risk of a pathological increase in the relative wall thickness (RW) (more than 42%) by 3.6% (95% CI 1.02-1.05%, p=0.000). And an increase in plasma GGTP activity by 1 U/l increased the risk of developing LV hypertrophy and LV concentric hypertrophy by 7.2% (95% CI 1.03-1.13%, p=0.002) and 2.6% (95% CI 1.02-1.08%, p=0.048), respectively. With an increase in FLI by 1 c.u. increased the likelihood of a patient developing concentric LV hypertrophy by 2.1% (95% CI 1.01-1.04%, p=0.005). The specificity and sensitivity of the models for OTS were 80.1% and 91.4%, for LV hypertrophy — 75.0% and 78.0%, for concentric LV hypertrophy — 71.3% and 77.0%, respectively.

CONCLUSION

In patients with arterial hypertension and non-alcoholic fatty liver disease, compared with patients with isolated arterial hypertension, in the absence of statistically significant differences in the stage and degree of arterial hypertension, there are statistically significantly higher indicators reflecting left ventricular myocardial hypertrophy. When analyzing the types of left ventricular remodeling, it was found that in patients with arterial hypertension and non-alcoholic fatty liver disease, concentric hypertrophy of the left ventricle was statistically significantly more common (75.0% compared to 55.0%, respectively). When conducting a correlation analysis in patients with arterial hypertension and non-alcoholic fatty liver disease, statistically significant hepatocardial relationships of moderate strength were revealed: the liver steatosis index directly correlated with the mass of the left ventricular myocardium (r=0.3, p=0.001), the thickness of the posterior wall of the left ventricle (r=0.3, p=0.001), IVS interventricular septal thickness (r=0.3, p=0.001) and isovolumic relaxation time from the moment of aortic valve closure to the moment of mitral valve opening (r=0.25, p=0.005). Logistic regression analysis revealed statistically significant influence of changes in indicators of the functional state of the liver on the risk of pathological remodeling of the heart. Based on the values of the regression coefficients, it can be concluded that the covariates of alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, and hepatic steatosis index have a direct, and aspartate aminotransferase, inverse relationship with the risk of heart remodeling.