Fibrosis-4 index: A new marker to predict non-dipper blood pressure pattern in patients with newly diagnosed hypertension
Índice de fibrosis-4: un nuevo marcador para predecir el patrón de presión arterial no dipper en pacientes con hipertensión recién diagnosticada
Uğur Küçük, Kadir Arslan
Abstract
Introduction: Epicardial fat tissue (EFT) is a significant risk factor for cardiovascular diseases. This study aimed to investigate whether there is a relationship between the fibrosis-4 index (FIB-4 index) and EFT in newly-diagnosed hypertensive patients and explore the usability of the FIB-4 index in predicting non-dipper blood pressure (BP) pattern.
Materials and methods: Our case–control study consisted of 210 patients in 3 groups according to BP values, namely normotensive, dipper, and non-dipper groups. Transthoracic echocardiography and 24-h ambulatory BP monitoring were performed in all patients.
Results: The median FIB-4 index was higher in the non-dipper group [1.56 (1.10-2)] than in the dipper [1 (0.71-1.32)] and normotensive groups [0.96 (0.69-1.32)] (p < 0.001, for both). A positive correlation was observed between EFT and the FIB-4 index (r=0.389, p<0.001). In multivariate logistic regression analysis, EFT (odds ratio (OR): 0.506, 95% confidence interval (CI): 1.288-2.135; p<0.001) and FIB-4 index (OR: 1.099, 95% CI: 1.621–5.556; p<0.001) were found to be independent predictors of non-dipper BP. In the receiver operating characteristic curve analysis, the FIB-4 index had 68% sensitivity and 72% specificity at a value >1.25 (area under the curve: 0.751, 95%CI: 0.679-0.823, p<0.001).
Conclusions: In newly-diagnosed hypertensive people, the FIB-4 index is related to non-dipper BP patterns. FIB-4 index appears to be a helpful tool in assessing risk associated with cardiovascular disease.
Keywords
Resumen
Introducción: El tejido graso epicárdico (TGE) es un importante factor de riesgo de enfermedades cardiovasculares. Este estudio tuvo como objetivo investigar si existe una relación entre el índice de fibrosis-4 (índice FIB-4) y TGE en pacientes hipertensos recién diagnosticados y explorar la utilidad del índice FIB-4 para predecir la presión arterial (PA) no dipper. patrón.
Materiales y métodos: Nuestro estudio de casos y controles consistió en 210 pacientes en 3 grupos según los valores de PA, a saber, grupos normotensos, dipper y no dipper. A todos los pacientes se les realizó ecocardiografía transtorácica y monitorización ambulatoria de la PA de 24 h.
Resultados: La mediana del índice FIB-4 fue mayor en el grupo no dipper [1,56 (1,10-2)] que en los grupos dipper [1 (0,71-1,32)] y normotensos [0,96 (0,69-1,32)] (p<0.001, para ambos). Se observó una correlación positiva entre TGE y el índice FIB-4 (r = 0,389, p < 0,001). En análisis de regresión logística multivariante, EFT (odds ratio (OR): 0,506, intervalo de confianza (IC) 95%: 1,288-2,135; p<0,001) e índice FIB-4 (OR: 1,099, IC95%: 1,621-5,556; p<0,001) resultaron ser predictores independientes de PA no dipper. En el análisis de la curva característica operativa del receptor, el índice FIB-4 tuvo una sensibilidad del 68 % y una especificidad del 72 % a un valor >1,25 (área bajo la curva: 0,751, IC95%: 0,679-0,823, p<0,001).
Conclusiones: En hipertensos de nuevo diagnóstico, el índice FIB-4 se relaciona con patrones de PA no dipper. El índice FIB-4 parece ser una herramienta útil para evaluar el riesgo asociado con la enfermedad cardiovascular.
Palabras clave
References
1. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. doi: 10.1016/S0140-6736(18)32203-7.
2. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912.
3. O'Brien E, White WB, Parati G, Dolan E. Ambulatory blood pressure monitoring in the 21st century. J Clin Hypertens (Greenwich). 2018;20(7):1108-11. doi: 10.1111/jch.13275.
4. White WB. Ambulatory blood-pressure monitoring in clinical practice. N Engl J Med. 2003;348(24):2377-8. doi: 10.1056/NEJMp030057.
5. Mancia G, Di Rienzo M, Parati G. Ambulatory blood pressure monitoring use in hypertension research and clinical practice. Hypertension. 1993;21(4):510-24. doi: 10.1161/01.hyp.21.4.510.
6. Malavazos AE, Di Leo G, Secchi F, Lupo EN, Dogliotti G, Coman C, et al, Iacobellis G. Relation of echocardiographic epicardial fat thickness and myocardial fat. Am J Cardiol. 2010;105(12):1831-5. doi: 10.1016/j.amjcard.2010.01.368.
7. Ahn SG, Lim HS, Joe DY, Kang SJ, Choi BJ, Choi SY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart. 2008;94(3):e7. doi: 10.1136/hrt.2007.118471.
8. Iacobellis G, Gao YJ, Sharma AM. Do cardiac and perivascular adipose tissue play a role in atherosclerosis? Curr Diab Rep. 2008;8(1):20-4. doi: 10.1007/s11892-008-0005-2.
9. Teijeira-Fernandez E, Eiras S, Grigorian-Shamagian L, Fernandez A, Adrio B, Gonzalez-Juanatey JR. Epicardial adipose tissue expression of adiponectin is lower in patients with hypertension. J Hum Hypertens. 2008;22(12):856-63. doi: 10.1038/jhh.2008.75.
10. Shah AG, Smith PG, Sterling RK. Comparison of FIB-4 and APRI in HIV-HCV coinfected patients with normal and elevated ALT. Dig Dis Sci. 2011;56(10):3038-44. doi: 10.1007/s10620-011-1710-2.
11. Sumida Y, Yoneda M, Hyogo H, Itoh Y, Ono M, Fujii H, et al. Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012;12:2. doi: 10.1186/1471-230X-12-2.
12. Nakashima M, Sakuragi S, Miyoshi T, Takayama S, Kawaguchi T, Kodera N, et al. Fibrosis-4 index reflects right ventricular function and prognosis in heart failure with preserved ejection fraction. ESC Heart Fail. 2021;8(3):2240-7. doi: 10.1002/ehf2.13317.
13. Saito Y, Okumura Y, Nagashima K, Fukamachi D, Yokoyama K, Matsumoto N, et al. Impact of the Fibrosis-4 Index on Risk Stratification of Cardiovascular Events and Mortality in Patients with Atrial Fibrillation: Findings from a Japanese Multicenter Registry. J Clin Med. 2020;9(2):584. doi: 10.3390/jcm9020584.
14. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-25. doi: 10.1002/hep.21178.
15. Sengul C, Cevik C, Ozveren O, Duman D, Eroglu E, Oduncu V, et al. Epicardial fat thickness is associated with non-dipper blood pressure pattern
in patients with essential hypertension. Clin Exp Hypertens. 2012;34(3):165-70. doi: 10.3109/10641963.2011.577488.
16. Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr. 2009;22(12):1311-9; quiz 1417-8. doi: 10.1016/j.echo.2009.10.013.
17. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-57. doi: 10.1161/HYPERTENSIONAHA.120.15026.
18. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. doi: 10.1093/eurheartj/ehy339.
19. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20. doi: 10.1001/jama.2013.284427.
20. Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M, et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens. 2002;20(11):2183-9. doi: 10.1097/00004872-200211000-00017.
21. Talman AH, Psaltis PJ, Cameron JD, Meredith IT, Seneviratne SK, Wong DT. Epicardial adipose tissue: far more than a fat depot. Cardiovasc Diagn Ther. 2014;4(6):416-29. doi: 10.3978/j.issn.2223-3652.2014.11.05.
22. van Woerden G, van Veldhuisen DJ, Gorter TM, van Empel VPM, Hemels MEW, Hazebroek EJ, et al. Importance of epicardial adipose tissue localization using cardiac magnetic resonance imaging in patients with heart failure with mid-range and preserved ejection fraction. Clin Cardiol. 2021;44(7):987-93. doi: 10.1002/clc.23644.
23. Tanindi A, Erkan AF, Ekici B. Epicardial adipose tissue thickness can be used to predict major adverse cardiac events. Coron Artery Dis. 2015;26(8):686-91. doi: 10.1097/MCA.0000000000000296.
24. Lu YY, Huang SY, Lin YK, Chen YC, Chen YA, Chen SA, et al. Epicardial adipose tissue modulates arrhythmogenesis in right ventricle outflow tract cardiomyocytes. Europace. 2021;23(6):970-7. doi: 10.1093/europace/euaa412.
25. Kim BJ, Cho KI, Choi JH, Park DH, Yu GI, Im SI, et al. Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients. J Cardiovasc Ultrasound. 2016;24(4):294-302. doi: 10.4250/jcu.2016.24.4.294.
26. Laukkanen JA, Khan H, Kurl S, Willeit P, Karppi J, Ronkainen K, et al. Left ventricular mass and the risk of sudden cardiac death: a population-based study. J Am Heart Assoc. 2014;3(6):e001285. doi: 10.1161/JAHA.114.001285.
27. Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991;83(6):1849-65. doi: 10.1161/01.cir.83.6.1849.
28. Halliday BP, Prasad SK. The Interstitium in the Hypertrophied Heart. JACC Cardiovasc Imaging. 2019;12(11 Pt 2):2357-68. doi: 10.1016/j.jcmg.2019.05.033.
29. Yöntem M , Erdoğdu B , Akdoğan M , Kaleli S . [The Importance of Cardiac Markers in Diagnosis of Acute Myocardial Infarction]. OTSBD. 2017;2(4):11-7.
30. Kwiecinski J, Lennen RJ, Gray GA, Borthwick G, Boswell L, Baker AH, et al. Progression and regression of left ventricular hypertrophy and myocardial fibrosis in a mouse model of hypertension and concomitant cardiomyopathy. J Cardiovasc Magn Reson. 2020;22(1):57. doi: 10.1186/s12968-020-00655-7.
31. Moczulska B, Zechowicz M, Leśniewska S, Osowiecka K, Gromadziński L. The Impact of Obesity on Nighttime Blood Pressure Dipping. Medicina (Kaunas). 2020;56(12):700. doi: 10.3390/medicina56120700.
32. Chen YK, Ni ZX, Li W, Xiao WM, Liu YL, Liang WC, et al. Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study. J Stroke Cerebrovasc Dis. 2021;30(5):105673. doi: 10.1016/j.jstrokecerebrovasdis.2021.105673.
33. Lempiäinen PA, Vasunta RL, Bloigu R, Kesäniemi YA, Ukkola OH. Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up. Blood Press. 2019;28(5):300-8. doi: 10.1080/08037051.2019.1615369.
34. Iwasaki Y, Shiina K, Matsumoto C, Nakano H, Fujii M, Yamashina A, et al. Correlation of the Fatty Liver Index with the Pathophysiological Abnormalities Associated with Cardiovascular Risk Markers in Japanese Men without any History of Cardiovascular Disease: Comparison with the Fibrosis-4 Score. J Atheroscler Thromb. 2021;28(5):524-34. doi: 10.5551/jat.56945.
Submitted date:
11/29/2021
Reviewed date:
12/26/2021
Accepted date:
01/18/2022
Publication date:
01/18/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email