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. 2022 Dec;9(6):3985-3994.
doi: 10.1002/ehf2.14087. Epub 2022 Aug 22.

Liver fibrosis scores and atrial fibrillation incidence in heart failure with preserved ejection fraction

Xiao Liu  1   2   3 , Wenya Chen  1   2 , Wen Shao  4 , Yuan Jiang  1   2 , Zhengyu Cao  1   2 , Wanbing He  1   2 , Maoxiong Wu  1   2 , Zhiteng Chen  1   2 , Jianyong Ma  5 , Yangxin Chen  1   2 , Peng Yu  4 , Yuling Zhang  1   2   3 , Jingfeng Wang  1   2   3
Affiliations

Liver fibrosis scores and atrial fibrillation incidence in heart failure with preserved ejection fraction

Xiao Liu et al. ESC Heart Fail. 2022 Dec.

Abstract

Aim: Non-alcoholic fatty liver disease (NAFLD)-related advanced liver fibrosis (Stage 3 or 4) was reported to be linked to worse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). This study aims to assess the relationship between liver fibrosis scores and new-onset atrial fibrillation (AF) incidence in patients with HFpEF in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.

Methods and results: Baseline liver fibrosis levels, assessed by NAFLD fibrosis score (NFS) or Fibrosis-4 index (FIB-4), with AF incidence were expressed as hazard ratios (HRs) using the Cox proportional hazard model. The risk for advanced fibrosis was estimated to be 21.5% (447/2072) as assessed by FIB-4 (>3.25) and 4.2% (88/2072) as assessed by NFS (>0.676) in HFpEF patients without baseline AF. After a median follow-up of 3.11 years, 106 new-onset AF cases occurred. In multivariate analysis, elevated NFS [NFS = -1.455-0.676: HR 2.44, 95% confidence interval (CI) 1.27-4.68; NFS > 0.676: HR 3.36, 95% CI 1.27-6.80; per 1 unit increase: HR 1.15, 95% CI 1.01-1.32], not FIB-4 (FIB-4 = 1.45-3.25: HR 1.02, 95% CI 0.67-1.55; FIB-4 > 3.25: HR 1.69, 95% CI 0.76-3.79; per 1 unit increase: HR 1.13, 95% CI 0.93-1.37), was associated with increased AF incidence. The NFS (C-index 0.662), not FIB-4 (C-index 0.531), had a moderate predictive ability in predicting incident AF.

Conclusions: Among patients with HFpEF, the risk of advanced liver fibrosis is associated with an increased incidence of new-onset AF and may be a novel predictor for new-onset AF. Additional studies are needed to confirm our results.

Keywords: Atrial fibrillation; FIB-4; Heart failure; Liver fibrosis; NFS; Risk prediction.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Flow chart of study selection of liver fibrosis scores from the TOPCAT trial. AF, atrial fibrillation; ALB, albumin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; PLT, platelet; TOPCAT, Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial.
Figure 2
Figure 2
Kaplan–Meier curves for AF incidence across NFS and FIB‐4 groups in patients with heart failure with preserved ejection fraction. NFS, non‐alcoholic fatty liver disease fibrosis score; FIB‐4, Fibrosis‐4 index; AF, atrial fibrillation. Calculations of FIB‐4 and NFS are described in the Methods section.
Figure 3
Figure 3
The receiver operating characteristic curves for predicting atrial fibrillation incidence in patients with heart failure with preserved ejection fraction, assessed by NFS and FIB‐4 scores. NFS, non‐alcoholic fatty liver disease fibrosis score; FIB‐4, Fibrosis‐4 index. The C‐statistic of the NFS and FIB‐4 score was calculated as category variables using a crude Cox regression model.
See this image and copyright information in PMC

References

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