M.N. Dolzhenko, L.I. Konoplyanik , Yu.V. Lymar, A.Yа. BazylevychEndothelial dysfunction in patients with postinfarction ischemic cardiomyopathy combined with non-alcoholic fatty liver disease

The aim – to estimate endothelial dysfunction (ED) in CAD patients combined with non-alcoholic fatty liver disease (NAFLD), and evaluate treatment with ursodeoxycholic acid (UDCA).
Material and methods. 139 patients were examined, mean age 59.7±3.9 years, among them 112 (81 %) men and 27 (19 %) women. All patients were divided into four groups depending on LV ejection fraction (EF) and NAFLD presence: 1 – patients with EF ≤ 35 % combined with NAFLD (35 patients); 2 – patients with EF > 35 % combined with NAFLD (34 patients); 3 – patients with EF ≤ 35 % without NAFLD (36 patients); 4 – patients with EF > 35 % without NAFLD (34 patients). All patients were administered antiischemic, antihypertensive and lipid-lowering treatment. Endothelial function was evaluated according to Celermayer – Sorensen test.
Results. The lowest level of endothelium-dependent vasodilation (EDVD) was found in patients of group 1, being significantly lower than in groups 2 and 3 (2.3±1.4 vs. 5.0±0.6 and 4.6±0.7, respectively, Р<0.0001), reflecting more advanced ED in the patients with EF ≤ 35 % combined with NAFLD. The lowest level of endothelium-independent vasodilation (EIVD) was diagnosed in group 1, being significantly lower than in groups 2 and 4 (12.5±1.7 vs. 18.2±1.9 and 19.1±2.0, Р<0.0001, respectively). Patients with CAD with concomitant NAFLD were administered UDCA 12–15 mg/kg. Results were evaluated in 1 and 6 months. In one month EDVD value improved in all four groups. In 6 months further improvement was observed. EIVD in one month improved only in group 3; in 6 months – in the first three groups. Conclusions. EDVD depends upon LV systolic function (to more extent) and concomitant NAFLD. EIVD may worsen only in case of significant decrease of LV EF and does not depend on NAFLD. UDCA improves endothelial function, therefore, it may be recommended in patients with postinfarction ischemic cardiomyopathy, even those without concomitant NAFLD.

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