Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 6, December 2023, pages 429-436

The Association Between Non-Clinically Apparent Liver Fibrosis and Pulmonary Arterial Hypertension in Hispanic Patients

**Table 1.** Baseline Characteristics and NFS
	All patients (n = 96)	Low NFS (F0-F2) (n = 36)	Indeterminate NFS (n = 33)	Advanced NFS (F3-F4) (n = 27)	P-value (low versus advanced NFS)
Data are shown as median (interquartile range (IQR)) except for sex (%) and WHO-FC (mean (standard deviation (SD))). P values between low and advanced NFSs were calculated by Mann-Whitney U test for continuous variables, Chi-square for differences in gender and t-test for WHO-FC. Data are available for all patients, except data on CI are available for 80 patients in the entire cohort, 30 patients in the low NFS group and 19 patients in the advanced NFS group. Data on 6MWD are available for 84 patients in the entire cohort and 33 patients in the low NFS group. BMI: body mass index; CHD: congenital heart disease; CI: cardiac index; CTD: connective tissue disease; IPAH: idiopathic pulmonary arterial hypertension; mPAP: mean pulmonary artery pressure; mRAP: mean right atrial pressure; NFS: non-alcoholic fatty liver disease fibrosis score; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; PCWP: pulmonary capillary wedge pressure; 6MWD: 6-minute walk distance; WHO-FC: World Health Organization functional class.
Age (years)	49 (15)	48 (7)	57.6 (23)	59 (12)	0.014
Female (%)	69	86	23	55	< 0.05
BMI (kg/m²)	30.2 (12)	27.1 (12)	30.8 (11)	32.1 (22)	0.35
WHO-FC (I-IV)	2.3 (0.9)	2.4 (0.6)	2.6 (1)	2.9 (0.7)	< 0.05
WHO group					0.781
IPAH	47	18	19	10
CTD	30	11	8	11
CHD	19	7	6	6
mRAP (mm Hg)	8 (14)	8 (4)	9.6 (5)	11.5 (16)	< 0.05
mPAP (mm Hg)	42 (12)	38 (17.1)	77 (14.5)	43 (23.2)	0.19
PCWP (mm Hg)	9 (5)	10 (7)	10.9 (4)	11 (5)	0.60
CI (L/min/m²)	2.4 (0.8)	2.9 (0.9)	3.1 (1.7)	2.7 (1.2)	0.41
6MWD (m)	358 (178)	399 (178)	368 (236)	288 (184)	< 0.05
NT-proBNP (ng/L)	1,853 (1,856)	1,050 (1,178)	1,845 (2,643)	2,323 (2,773)	< 0.05
NFS	-0.55 (2.5)	-2.6 (1.1)	-0.4 (1.46)	1.4 (2.5)	< 0.05
Diabetes (%)	27.1	13.9	21.1	51.9	0.001
Systemic hypertension (%)	17.7	16.7	12.1	25.6	0.214
Hyperlipidemia (%)	11.5	8.3	9.1	18.5	0.206
Obesity (%)	37.5	25.0	45.5	44.4	0.397
One or more risk factors for metabolic syndrome (%)	67.7	56.0	69.7	81.5	0.035

Table 1. Baseline Characteristics and NFS

All patients (n = 96)

Low NFS (F0-F2) (n = 36)

Indeterminate NFS (n = 33)

Advanced NFS (F3-F4) (n = 27)

P-value (low versus advanced NFS)

Data are shown as median (interquartile range (IQR)) except for sex (%) and WHO-FC (mean (standard deviation (SD))). P values between low and advanced NFSs were calculated by Mann-Whitney U test for continuous variables, Chi-square for differences in gender and t-test for WHO-FC. Data are available for all patients, except data on CI are available for 80 patients in the entire cohort, 30 patients in the low NFS group and 19 patients in the advanced NFS group. Data on 6MWD are available for 84 patients in the entire cohort and 33 patients in the low NFS group. BMI: body mass index; CHD: congenital heart disease; CI: cardiac index; CTD: connective tissue disease; IPAH: idiopathic pulmonary arterial hypertension; mPAP: mean pulmonary artery pressure; mRAP: mean right atrial pressure; NFS: non-alcoholic fatty liver disease fibrosis score; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; PCWP: pulmonary capillary wedge pressure; 6MWD: 6-minute walk distance; WHO-FC: World Health Organization functional class.

Age (years)

49 (15)

48 (7)

57.6 (23)

59 (12)

0.014

Female (%)

< 0.05

BMI (kg/m²)

30.2 (12)

27.1 (12)

30.8 (11)

32.1 (22)

0.35

WHO-FC (I-IV)

2.3 (0.9)

2.4 (0.6)

2.6 (1)

2.9 (0.7)

< 0.05

WHO group

0.781

IPAH

CTD

CHD

mRAP (mm Hg)

8 (14)

8 (4)

9.6 (5)

11.5 (16)

< 0.05

mPAP (mm Hg)

42 (12)

38 (17.1)

77 (14.5)

43 (23.2)

0.19

PCWP (mm Hg)

9 (5)

10 (7)

10.9 (4)

11 (5)

0.60

CI (L/min/m²)

2.4 (0.8)

2.9 (0.9)

3.1 (1.7)

2.7 (1.2)

0.41

6MWD (m)

358 (178)

399 (178)

368 (236)

288 (184)

< 0.05

NT-proBNP (ng/L)

1,853 (1,856)

1,050 (1,178)

1,845 (2,643)

2,323 (2,773)

< 0.05

NFS

-0.55 (2.5)

-2.6 (1.1)

-0.4 (1.46)

1.4 (2.5)

< 0.05

Diabetes (%)

27.1

13.9

21.1

51.9

0.001

Systemic hypertension (%)

17.7

16.7

12.1

25.6

0.214

Hyperlipidemia (%)

11.5

8.3

9.1

18.5

0.206

Obesity (%)

37.5

25.0

45.5

44.4

0.397

One or more risk factors for metabolic syndrome (%)

67.7

56.0

69.7

81.5

0.035

**Table 2.** Correlation of NFS With Baseline Variables
Variables	NFS (F0-F4)	P-value
Correlations between continuous variables were assessed using the Pearson correlation coefficient. Spearman rank correlation was used to assess the correlation for nominal and categorical variables. BMI: body mass index; CI: cardiac index; mPAP: mean pulmonary artery pressure; mRAP: mean right atrial pressure; NFS: non-alcoholic fatty liver disease fibrosis score; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; PCWP: pulmonary capillary wedge pressure; 6MWD: 6-minute walk distance; WHO-FC: World Health Organization functional class.
Age (years)	0.342	0.041
Gender	0.355	0.009
BMI (kg/m²)	0.131	0.350
WHO-FC (I-IV)	0.35	0.005
mRAP (mm Hg)	0.273	0.031
mPAP (mm Hg)	0.21	0.27
PCWP (mm Hg)	-0.073	0.69
CI (L/min/m²)	-0.117	0.423
6MWD (m)	-0.485	0.001
NT-proBNP (ng/L)	0.321	0.010

Table 2. Correlation of NFS With Baseline Variables

Variables

NFS (F0-F4)

P-value

Correlations between continuous variables were assessed using the Pearson correlation coefficient. Spearman rank correlation was used to assess the correlation for nominal and categorical variables. BMI: body mass index; CI: cardiac index; mPAP: mean pulmonary artery pressure; mRAP: mean right atrial pressure; NFS: non-alcoholic fatty liver disease fibrosis score; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; PCWP: pulmonary capillary wedge pressure; 6MWD: 6-minute walk distance; WHO-FC: World Health Organization functional class.

Age (years)

0.342

0.041

Gender

0.355

0.009

BMI (kg/m²)

0.131

0.350

WHO-FC (I-IV)

0.35

0.005

mRAP (mm Hg)

0.273

0.031

mPAP (mm Hg)

0.21

0.27

PCWP (mm Hg)

-0.073

0.69

CI (L/min/m²)

-0.117

0.423

6MWD (m)

-0.485

0.001

NT-proBNP (ng/L)

0.321

0.010

**Table 3.** Non-Invasive Risk Assessment Using Cox Regression Analysis
	Univariate model	Multivariate model
^aAdjusted for gender. ^bAdjusted for age and gender. Cox regression analysis was used to identify predictors of death during follow-up. CI: confidence interval; HR: hazard ratio; NFS: non-alcoholic fatty liver disease fibrosis score; 6MWD: 6-minute walk distance; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; WHO-FC: World Health Organization functional class.
NFS^a	2.4 (1.7 - 3.9)	0.001	2.0 (1.2 - 3.4)	0.031
NT-proBNP^b	1.1 (1.0 - 1.3)	0.003	1.0 (0.8 - 1.1)	0.312
6MWD^b	1.1 (1.0 - 1.1)	0.023	0.97 (0.8 - 1.1)	0.495
WHO-FC^b	2.8 (1.5 - 4.2)	0.001	1.6 (1.3 - 3.0)	0.031

Table 3. Non-Invasive Risk Assessment Using Cox Regression Analysis

Univariate model

Multivariate model

HR (95% CI)

P-value

HR (95% CI)

P-value

^aAdjusted for gender. ^bAdjusted for age and gender. Cox regression analysis was used to identify predictors of death during follow-up. CI: confidence interval; HR: hazard ratio; NFS: non-alcoholic fatty liver disease fibrosis score; 6MWD: 6-minute walk distance; NT-proBNP: N-terminal-pro-B-type natriuretic peptide; WHO-FC: World Health Organization functional class.

NFS^a

2.4 (1.7 - 3.9)

0.001

2.0 (1.2 - 3.4)

0.031

NT-proBNP^b

1.1 (1.0 - 1.3)

0.003

1.0 (0.8 - 1.1)

0.312

6MWD^b

1.1 (1.0 - 1.1)

0.023

0.97 (0.8 - 1.1)

0.495

WHO-FC^b

2.8 (1.5 - 4.2)

0.001

1.6 (1.3 - 3.0)

0.031