The Association of Alanine Aminotransferase Levels With Myocardial Perfusion Imaging and Cardiovascular Morbidity.
The Association of Alanine Aminotransferase Levels With Myocardial Perfusion Imaging and Cardiovascular Morbidity.
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DOI：
10.1177/10742484221074585
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发表时间：
2022-01
影响因子：
2.6
通讯作者：
Etzion O
中科院分区：
文献类型：
--
作者：
Yardeni D;Toledano R;Novack V;Shalev A;Wolak A;Rotman Y;Etzion O
研究表明，非酒精性脂肪性肝病（NAFLD）与心血管疾病（CVD）的独立风险相关。我们利用一大批接受单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）的患者来确定丙氨酸转氨酶（ALT）作为推测NAFLD的替代标志物与心肌缺血和死亡率之间的关系。我们回顾性地评估了1997-2008年间接受评估的个体的SPECT-MPI结果和医疗记录。我们排除了已知的非nafld肝病、ALT值<17或>340 u/L和未进行肝脏检查的患者。ALT升高的病例被归类为假定的NAFLD。主要终点为SPECT-MPI异常。次要终点包括心源性死亡、急性心肌梗死和全因死亡率。在26,034例接受SPECT-MPI治疗的患者中，11,324例符合纳入标准。1635例（14.4%）患者ALT升高。SPECT-MPI结果在ALT升高的受试者和对照组之间没有显著差异。在5年随访中，ALT升高与心源性死亡或急性心肌梗死复合终点的风险增加（风险比（HR） 1.3, 95%可信区间（CI） 1.01-1.67）和全因死亡率（HR）相关。1.27, CI 1.02-1.58)，但仅适用于SPECT-MPI正常的患者。SPECT-MPI异常患者的长期死亡率不受ALT的调节，可能反映了已经存在的高风险和既定的心血管疾病。然而，SPECT-MPI正常的患者如果ALT水平升高，未来发生心脏事件的风险会增加，这表明NAFLD在CVD早期阶段的重要作用。
Studies suggest that non-alcoholic fatty liver disease (NAFLD) is associated with an independent risk of cardiovascular disease (CVD). We utilized a large cohort of patients undergoing myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) to determine the association between alanine aminotransferase (ALT) as a surrogate marker for presumed NAFLD, and the presence of myocardial ischemia and mortality. We retrospectively assessed SPECT-MPI results and medical records of individuals evaluated between 1997–2008. We excluded patients with known non-NAFLD liver diseases, ALT values <17 or >340 u/L and absent liver tests. Elevated ALT cases were classified as presumed NAFLD. The primary endpoint was abnormal SPECT-MPI. Secondary endpoints included cardiac death, acute myocardial infarction and all-cause mortality Of 26,034 patients who underwent SPECT-MPI, 11,324 met inclusion criteria. 1,635 (14.4%) patients had elevated ALT. SPECT-MPI results did not differ significantly between subjects with elevated ALT and controls. Elevated ALT was associated with increased risk for the composite endpoint of cardiac death or acute myocardial infarction at 5-year follow-up (Hazard ratio (HR) 1.3, 95% Confidence Interval (CI) 1.01–1.67) and in all-cause mortality (HR. 1.27, CI 1.02–1.58) but only in patients with normal SPECT-MPI. The long-term mortality of patients with abnormal SPECT-MPI is not modulated by ALT, likely reflecting an already high risk and established CVD. However, patients with normal SPECT-MPI are at increased risk for a future cardiac event if they have an elevated ALT level, suggesting an important role for NAFLD in earlier stages of CVD.
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DOI：
10.1007/s12265-011-9290-2
发表时间：
2011-08-01
影响因子：
3.4
作者：
Beller, George A.;Heede, Ruth C.
通讯作者：
Heede, Ruth C.
影响因子：
4.2
作者：
Caussy C;Aubin A;Loomba R
通讯作者：
Loomba R
影响因子：
2.8
作者：
Lu H;Liu H;Hu F;Zou L;Luo S;Sun L
通讯作者：
Sun L
DOI：
10.1136/bmj.d6891
发表时间：
2011-11-18
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Lazo M;Hernaez R;Bonekamp S;Kamel IR;Brancati FL;Guallar E;Clark JM
通讯作者：
Clark JM
影响因子：
6.8
作者：
Jung, Dong-Hyuk;Lee, Yong-Jae;Lee, Hye-Ree
通讯作者：
Lee, Hye-Ree