Особливості структурно-функціональних порушень серця при коморбідності неалкогольної жирової хвороби печінки та гіпертонічної хвороби

Abstract

The purpose of the study was to establish the features of structural and functional remodeling of the heart in patients with non-alcoholic fatty liver disease in combination with hypertension. Materials and methods. The study included 211 patients, of whom 121 had comorbidity of non-alcoholic fatty liver disease and hypertension, 60 patients had isolated non-alcoholic fatty liver disease, and 30 patients had isolated hypertensive disease. The control group consisted of 20 healthy individuals. To study the structural and functional properties of the myocardium, patients underwent ultrasound of the heart according to conventional methods. Results and discussion. Examination of patients showed that the mass of the left ventricular myocardium in both groups of patients with hypertension were significantly higher than in the control group and the non-alcoholic fatty liver disease group (p < 0.001). The presence of comorbidity with non-alcoholic fatty liver disease did not lead to a further increase in left ventricular myocardial mass in patients with hypertension (p > 0.05). It was found that patients with hypertension in the presence and absence of non-alcoholic fatty liver disease are characterized by an increase in the volume of the left and right atria, as well as the diameters of the left atrium and aorta, compared with the control and the non-alcoholic fatty liver disease groups. At the same time, there were no significant differences between the groups of patients with hypertension in terms of both the presence and absence of comorbidity (p > 0.05). In addition, the main indicator of systolic function of the left ventricle – ejection fraction – was evaluated. This figure was significantly lower in the two groups of patients with hypertension than in the control group and the non-alcoholic fatty liver disease group (p < 0.001). The presence of comorbidity with non-alcoholic fatty liver disease did not affect this indicator (p > 0.05). Among the two groups of patients with hypertension, patients with concentric hypertrophy significantly prevailed. There was a significant increase in the value of a very important integral indicator of diastolic function E / e in patients of all groups, which significantly distinguished them from the control group (p < 0.001). This indicated the presence of diastolic dysfunction in these patients. There is no significant difference in the geometry of the heart and the types of transmitral blood flow between patients with hypertension depending on the presence of concomitant non-alcoholic fatty liver disease. Conclusion. Thus, there is no significant difference between the indicators of left ventricle systolic function in the groups of patients with comorbidity and isolated hypertension. At the same time, there were signs of deterioration of diastolic function in the comorbidity group, which was manifested by an increase in E / e. Deterioration of diastolic function was recorded in the group of isolated non-alcoholic fatty liver disease. These facts may indicate the influence of non-alcoholic fatty liver disease itself on the formation of diastolic dysfunction, both in the presence of hypertension and in its absence. The presence of concomitant non-alcoholic fatty liver disease does not affect transmitral blood flow in patients with hypertension