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

Journal of Clinical Medicine

Shoji Hanada¹  Naoya Matsumoto²  Katsuaki Yokoyama²  Daisuke Fukamachi³  Atsushi Hirayama³  Koichi Nagashima³  Yasuo Okumura³  Yuki Saito³  Kimie Ohkubo⁴  Satoru Itou⁵  Ken Arima⁶  Keiichiro Kuronuma⁷  Eizo Tachibana⁷  Hideyuki Ando⁸  Kunio Kondo⁹  Tomobumi Kotani^1,10  Yasumi Ohno^1,11  Motoyuki Onikura^1,12  Toshiaki Kojima^1,13  Kazumiki Nomoto^1,14  Kazumasa Sonoda^1,14  Seiji Fukushima^1,15  Fumiyuki Takahashi^1,16  Michiaki Matsumoto^1,17  Toshihiko Nishida^1,17  Koji Oiwa^1,17 

[1] Asaka Medical Center, 1340-1 Mizonuma, Asaka, Saitama 351-0000, Japan;Department of Cardiology, Nihon University Hospital, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan;Division of Cardiology, Nihon University Itabashi Hospital, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan;Itabashi Medical Association Hospital, 3-12-6 Takashimadaira, Itabashi-ku, Tokyo 175-0082, Japan;Itou Cardiovascular Clinic, 2-4 Higashisumiyoshi, Tokorozawa, Saitama 359-1124, Japan;Kasukabe Municipal Hospital, 6-7-1 Chuo, Kasukabe, Saitama 344-0067, Japan;Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi, Saitama 333-0833, Japan;Keiai Clinic, 3-10-23 Mukaihara, Itabashi-ku, Tokyo 173-0036, Japan;Kondo Clinic, 2-36-24 Shimoigusa, Suginami-ku, Tokyo 167-0022, Japan;Makita General Hospital, 1-34-6 Omorikita, Ota-ku, Tokyo 143-0016, Japan;Ohno Medical Clinic, 1-36-1 Itabashi, Itabashi-ku, Tokyo 173-0004, Japan;Onikura Clinic, 1-26-13 Katsutadai, Yachiyo, Chiba, 276-0023, Japan;Sekishindo Hospital, 25-19 Wakitahoncho, Kawagoe, Saitama 350-1123, Japan;Tokyo Rinkai Hospital, 1-4-2 Rinkai-cho, Edogawa-ku, Tokyo 134-0086, Japan;Ukima Central Hospital, 2-21-19 Akabanekita, Kita-ku, Tokyo 115-0052, Japan;Yasuda Hospital, 1-13-9 Narimasu, Itabashi-ku, Tokyo 175-0094, Japan;Yokohama Chuo Hospital, 268 Yamashitacho, Naka-ku, Yokohama, Kanagawa 231-0023, Japan;

关键词: adverse clinical events;    liver fibrosis;    fibrosis-4 index;    atrial fibrillation;   

DOI  :  10.3390/jcm9020584

来源: DOAJ

【 摘 要 】

Background: Liver diseases drive the development and progression of atrial fibrillation (AF). The Fibrosis-4 (FIB4) index is a non-invasive scoring method for detecting liver fibrosis, but the prognostic impact of using it for AF patients is still unknown. Herein, we evaluated using the FIB4 index as a risk assessment tool for cardiovascular events and mortality in patients with AF. Methods: We performed a post-hoc analysis of a prospective, observational multicenter study. A total of 3067 patients enrolled in a multicenter Japanese registry were grouped as first tertile (FIB4 index < 1.75, n = 1022), second tertile (1.75 ≤ FIB4 index < 2.51, n = 1022), and third tertile (FIB4 index ≥ 2.51, n = 1023). Results: The third tertile had statistically significant results: older age, lower body mass index, increased heart failure prevalence, and lower clearances of hemoglobin and creatinine (all p < 0.05). During the follow-up period, incidences of major bleeding, cardiovascular events, and all-cause mortality were significantly higher for the third tertile (all p < 0.05). After multivariate adjustment, the third tertile associated independently with cardiovascular events (HR 1.72; 95% CI 1.31−2.25) and all-cause mortality (HR 1.43; 95% CI 1.06−1.95). Adding the FIB4 index to a baseline model with CHA₂DS₂-VASc score improved the prediction of cardiovascular events and all-cause mortality, as shown by the significant increase in the C-statistic (all p < 0.05), net reclassification improvement (all p < 0.001), and integrated discrimination improvement (all p < 0.001). A FIB4 index ≥ 2.51 most strongly associated with cardiovascular events and all-cause mortality in AF patients with high CHADS₂ scores (all p < 0.001). Conclusions: The FIB4 index is independently associated with risks of cardiovascular events and all-cause mortality in AF patients.

【 授权许可】

Unknown