letter to the editor Wien Klin Wochenschr (2015) 127:75–76 DOI 10.1007/s00508-014-0621-6
Screening of nonalcoholic fatty liver disease in patients with coronary heart disease by transient elastography: proceed with caution Masato Yoneda · Kento Imajo · Satoru Saito · Atsushi Nakajima
Received: 31 March 2014 / Accepted: 28 September 2014 / Published online: 11 October 2014 © Springer-Verlag Wien 2014
Dear Editor We read the article by Mikolasevic et al. [1] with great interest. Mikolasevic et al. using transient elastography (TE) as a screening tool to detect nonalcoholic fatty liver disease (NAFLD) in patients with coronary heart disease was a novel approach. We have previously reported, for the first time in the world, that TE can be used to measure the severity of fibrosis in patients with NAFLD [2, 3], and TE has been validated by several meta-analyses today [4, 5]. TE received the long-awaited approval from US Food and Drug Administration on April 5, 2013, and it is expected that the use of TE will subsequently increase in not only Europe but also the USA. Mikolasevic et al. found that the patients with multiple vessels involved have a higher tendency to have liver stiffness more than 7 kPa [1]. We completely agree that their finding is clinically important because there is mounting evidence that NAFLD is significantly correlated with the risk of cardiovascular disease (CVD). In their study, they strictly excluded heart failure patients to avoid the recruitment of those with a secondary cause of elevated liver enzymes caused by heart failure. However, we should pay attention that this exclusion criterion was also important to remove an influence of heart failure on liver stiffness, as some studies have reported that patients with heart failure have increased liver stiffness [6–8]. M. Yoneda, MD, PhD () Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, 1500 NW 12th Avenue, Suite 1101, 33136 Miami, FL, USA e-mail: [email protected] S. Saito · K. Imajo · M. Yoneda, MD, PhD · A. Nakajima Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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TE is an extremely useful tool to access liver fibrosis and steatosis because of its high sensitivity, low cost, rapid capability for data acquisition, and lack of complications. Most importantly, these diagnostic tests are commonly accepted by patients as part of their routine evaluation and care. With the increased incidence of obesity and diabetes globally, the findings by Mikolasevic et al. will become increasingly important. However, when measuring liver stiffness in NAFLD with heart disease, we have to take care not to misunderstand the meaning. In conclusion, we hope the contents of this letter are useful to support the use of TE in NAFLD patients with CVD. Conflict of interest The authors declare no conflict of interest.
References 1. Mikolasevic I, Orlic L, Milic S, et al. Nonalcoholic fatty liver disease (NAFLD) proven by transient elastography in patients with coronary heart disease. Wien Klin Wochenschr. 2014;126:474–9. 2. Yoneda M, Yoneda M, Fujita K, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut. 2007;56:1330–1. 3. Yoneda M, Yoneda M, Mawatari H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis. 2008;40:371–8. 4. Musso G, Gambino R, Cassader M, et al. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43:617–49. 5. Kwok R, Tse YK, Wong GL, et al. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease—the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther. 2014;39:254–69.
Screening of nonalcoholic fatty liver disease in patients with coronary heart disease
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letter to the editor 6. Alegre F, Herrero JI, Iñarrairaegui M, et al. Increased liver stiffness values in patients with heart failure. Acta Gastroenterol Belg. 2013;76:246–50. 7. Taniguchi T, Sakata Y, Ohtani T, et al. Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am J Cardiol. 2014;113:552–8.
8.
Colli A, Pozzoni P, Berzuini A, et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010;257:872–8.
76 Screening of nonalcoholic fatty liver disease in patients with coronary heart disease
13
Screening of nonalcoholic fatty liver disease in patients with coronary heart disease by transient elastography: proceed with caution Masato Yoneda · Kento Imajo · Satoru Saito · Atsushi Nakajima
Received: 31 March 2014 / Accepted: 28 September 2014 / Published online: 11 October 2014 © Springer-Verlag Wien 2014
Dear Editor We read the article by Mikolasevic et al. [1] with great interest. Mikolasevic et al. using transient elastography (TE) as a screening tool to detect nonalcoholic fatty liver disease (NAFLD) in patients with coronary heart disease was a novel approach. We have previously reported, for the first time in the world, that TE can be used to measure the severity of fibrosis in patients with NAFLD [2, 3], and TE has been validated by several meta-analyses today [4, 5]. TE received the long-awaited approval from US Food and Drug Administration on April 5, 2013, and it is expected that the use of TE will subsequently increase in not only Europe but also the USA. Mikolasevic et al. found that the patients with multiple vessels involved have a higher tendency to have liver stiffness more than 7 kPa [1]. We completely agree that their finding is clinically important because there is mounting evidence that NAFLD is significantly correlated with the risk of cardiovascular disease (CVD). In their study, they strictly excluded heart failure patients to avoid the recruitment of those with a secondary cause of elevated liver enzymes caused by heart failure. However, we should pay attention that this exclusion criterion was also important to remove an influence of heart failure on liver stiffness, as some studies have reported that patients with heart failure have increased liver stiffness [6–8]. M. Yoneda, MD, PhD () Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, 1500 NW 12th Avenue, Suite 1101, 33136 Miami, FL, USA e-mail: [email protected] S. Saito · K. Imajo · M. Yoneda, MD, PhD · A. Nakajima Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
13
TE is an extremely useful tool to access liver fibrosis and steatosis because of its high sensitivity, low cost, rapid capability for data acquisition, and lack of complications. Most importantly, these diagnostic tests are commonly accepted by patients as part of their routine evaluation and care. With the increased incidence of obesity and diabetes globally, the findings by Mikolasevic et al. will become increasingly important. However, when measuring liver stiffness in NAFLD with heart disease, we have to take care not to misunderstand the meaning. In conclusion, we hope the contents of this letter are useful to support the use of TE in NAFLD patients with CVD. Conflict of interest The authors declare no conflict of interest.
References 1. Mikolasevic I, Orlic L, Milic S, et al. Nonalcoholic fatty liver disease (NAFLD) proven by transient elastography in patients with coronary heart disease. Wien Klin Wochenschr. 2014;126:474–9. 2. Yoneda M, Yoneda M, Fujita K, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut. 2007;56:1330–1. 3. Yoneda M, Yoneda M, Mawatari H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis. 2008;40:371–8. 4. Musso G, Gambino R, Cassader M, et al. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43:617–49. 5. Kwok R, Tse YK, Wong GL, et al. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease—the role of transient elastography and plasma cytokeratin-18 fragments. Aliment Pharmacol Ther. 2014;39:254–69.
Screening of nonalcoholic fatty liver disease in patients with coronary heart disease
75
letter to the editor 6. Alegre F, Herrero JI, Iñarrairaegui M, et al. Increased liver stiffness values in patients with heart failure. Acta Gastroenterol Belg. 2013;76:246–50. 7. Taniguchi T, Sakata Y, Ohtani T, et al. Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure. Am J Cardiol. 2014;113:552–8.
8.
Colli A, Pozzoni P, Berzuini A, et al. Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology. 2010;257:872–8.
76 Screening of nonalcoholic fatty liver disease in patients with coronary heart disease
13
