Matrix metalloproteinase-9 and connective tissue growth factor and their role in progression of hepato-myocardial fibrosis in patients with stable coronary heart disease combined with nonalcoholic fatty liver disease
Journal Title: Український терапевтичний журнал - Year 2018, Vol 0, Issue 1
Abstract
Objective — to determine the regularities of the stable coronary heart disease (CHD) progression in condition of the formation of hepatomyocardial fibrosis by serum levels of matrix metalloproteinase-9 (MMP-9) and connective tissue growth factor (CTGF) against the background of nonalcoholic fatty liver disease (NAFLD). Materials and methods. Examinations involved 300 patients with stable CHD and chronic heart failure II—III class NYHA were examined: 160 patients without NAFLD (Group I); 140 patients with NAFLD (Groups II—V). Patients with NAFLD were divided depending on the liver fibrosis stage. Among the patients of each group, patients with nonalcoholic steatosis and nonalcoholic steatohepatitis (NASH) were selected. All patients underwent routine clinical examinations, electrocardiography, coronary angiography, echocardiography, liver elastography, evaluation of the liver functional state, measurement of serum NT-proBNP, MMP-9 and CTGF levels. Results and discussion. It has been established, that formation of the signs of postinfarction myocardium remodeling depended on the liver fibrosis stage and increased with the NAFLD progression. Serum MMP--9 and CTGF levels increased depending on the NAFLD course and liver fibrosis stage. In particular, in patients with nonalcoholic steatosis, serum MMP-9 level was higher vs. Group I by 13.2 % (at stage F1), by 17.5 % (at stage F2), by 25.8 % (at stage F3), and by 36.4 % (at F4 stage) respectively (p < 0.05). In patients of Groups IIA, IIIA and IVA, serum CTGF level was higher by 12.5, 17.1 and 26.4 % vs. Group I (p < 0.05) respectively. Against the NASH background, serum MMP-9 and CTGF levels were significantly higher not only vs. their levels in Group I, but also vs. patient with nonalcoholic steatosis of the respective groups. Conclusions. It has been established that peculiarities of the stable CHD course against the NAFLD background was the formation of postinfarction myocardium remodeling, the progression of which significantly depends on the liver fibrosis stage, as it is detected by serum NT-proBNP levels. The presence of a positive correlation between serum MMP-9, CTGF levels and serum NT-proBNP, left ventricular myocardial mass index, and left ventricular ejection fraction levels, indicated their direct involvement in the formation of hepato-myocardial fibrosis, making it possible to consider them as potential noninvasive markers for the fibrosis diagnosis in patients with stable CHD, combined with NAFLD.
Authors and Affiliations
І. І. Vakalyuk, N. G. Virstyuk
Keywords
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