Measurement of the coronary flow velocity reserve in patients with non-alcoholic fatty liver disease

Binnur PINARBASI, Kadir DEMIR, Huseyin OFLAZ, Emel AHISHALI, Filiz AKYUZ, Ali ELITOK, Arif Oguzhan CIMEN, Ebru GOLCUK, Mine GULLUOGLU, Halim ISSEVER, Fatih BESISIK, Sabahattin KAYMAKOGLU (+1 others)
2012 The Turkish Journal of Gastroenterology  
Girifl ve Amaç: Endotel disfonksiyonu; ateroskleroz patogenezinde erken ve geri dönüflümlü bir aflamad›r. Koroner ak›m h›z› rezervi, epikardiyal koroner arterlerin endotel fonksiyonlar›n› ve koroner mikrosirkülatuvar dolafl›m fonksiyonlar›n› gösteren noninvaziv bir testtir. Bu çal›flma, alkol d›fl› ya¤l› karaci¤er hastalar›nda miyokardial mikrovasküler dolafl›m› ve karotis arter intima-media kal›nl›¤›n› de¤erlendirmek amac›yla düzenlendi. Gereç ve Yöntem: Alkol d›fl› ya¤l› karaci¤er hastal›¤›
more » ... an 24 hasta ile sa¤l›kl› kontrol 28 gönüllü çal›flmaya al›nd›. Hastalar karaci¤er biyopsi bulgular›na göre, alkol d›fl› ya¤l› karaci¤er ve alkol d›fl› steatohepatit hastalar› olmak üzere iki gruba ay-r›ld›. Koroner diastolik pik ak›m h›z›, bazal ve dipiridamol infüzyonu sonras› (hiperemik) transtorasik Doppler ultrasonografi ile ölçüldü. Hiperemik diastolik pik ak›m h›z›n›n bazale oran› hesapland› ve karotis arterlerin intima-media kal›nl›¤› ölçüldü. Bulgular: Bazal ortalama diastolik zirve ve diastolik ortalama ak›m h›zlar› alkol d›fl› ya¤l› karaci¤er hastal›¤› olan bireylerde, sa¤l›kl› kontrol grubu ile benzer bulundu. Ancak, hiperemik ortalama diastolik pik ve diastolik ortalama ak›m h›zlar› karfl›laflt›r›ld›¤›nda, alkol d›fl› ya¤l› karaci¤er hasta-lar› grubunda sa¤l›kl› kontrollerden daha düflük bulundu (s›ras›yla p=0.005 ve p=0.002). Koroner ak›m h›z› rezervi hastalar ve sa¤l›kl› kontrollerde s›ras›yla 1.65±0,36 ve 2.67±0.81 (p<0.001) saptand›. Koroner arter intima-media kal›nl›klar› ise, her iki grupta benzerdi. Alkol d›-fl› ya¤l› karaci¤er hastalar› kendi içlerinde alkol d›fl› ya¤l› karaci¤er ve alkol d›fl› steatohepatit olarak karfl›laflt›r›ld›¤›nda, koroner ak›m h›-z› rezervi ve karotis intima-media kal›nl›klar› aç›s›ndan fakl›l›klar› olmad›¤› görüldü. Sonuç: Çal›flmam›z alkol d›fl› ya¤l› karaci¤er has-tal›¤›nda önemli ölçüde bozulmufl olan koroner mikrovasküler dolafl›m ve endotel disfonksiyonunu noninvaziv olarak koroner ak›m h›z› rezervi ölçümü yoluyla gösteren ilk çal›flmad›r. Bozulmufl koroner ak›m h›z› rezervi, erken evre ateroskleroz bulgusu olup, alkol d›fl› ya¤l› ka-raci¤er hastal›¤›nda koroner hastal›¤›n›n öngörülmesinde önemli bir bulgu olabilir. Anahtar kelimeler: Endotel disfonksiyonu, koroner ak›m h›z› rezervi, metabolic sendrom, transtorasik Doppler ultrasonografi, intima-media kal›nl›¤›, alkol d›fl› ya¤l› karaci¤er hastal›¤› Background/aims: Endothelial dysfunction is an early and reversible feature in the pathogenesis of atherosclerosis. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. This study was designed to evaluate the carotid intima-media thickness and myocardial microvascular circulation in patients with non-alcoholic fatty liver disease. Materials and Methods: Twenty-four patients with non-alcoholic fatty liver disease and 28 healthy subjects were studied. According to the pathology of liver biopsies, patients with non-alcoholic fatty liver disease were divided into non-alcoholic fatty liver and nonalcoholic steatohepatitis groups. Coronary diastolic peak flow velocities were measured at baseline, and then dipyridamole infusion was measured by transthoracic Doppler echocardiography. The ratio of hyperemic to baseline diastolic peak velocities was calculated and the intima-media thicknesss of the carotid arteries were measured. Results: Baseline average diastolic peak and diastolic mean flow velocities were similar between non-alcoholic fatty liver disease patients and healthy subjects. However, hyperemic average diastolic peak and diastolic mean flow velocities were significantly lower in the patient groups compared to those in the controls (p=0.005 and p=0.002). Coronary flow velocity reserve was 1. 65±0.36 and 2.67±0.81 in patients and healthy subjects, respectively (p<0.001). The intima-media thickness was similar between the patients with non-alcoholic fatty liver disease and healthy subjects. The comparison of patients with non-alcoholic fatty liver and non-alcoholic steatohepatitis within the non-alcoholic fatty liver disease group with respect to coronary flow velocity reserve and intima-media thickness yielded no statistical differences. Conclusions: The present study showed that coronary flow velocity reserve, which establishes coronary microvascular and endothelial functions noninvasively, is significantly impaired in patients with non-alcoholic fatty liver disease. The impaired coronary flow velocity reserve-like early atherosclerotic changes may have value in the prediction of coronary artery disease in patients with non-alcoholic fatty liver disease.
doi:10.4318/tjg.2012.0489 pmid:23794311 fatcat:qfkslltyjva4forkypj5ixxvaq