The relationship between nonalcoholic fatty liver disease and epicardial adipose tissue thickness, carotid intima media thickness, and aortic propagation velocity

Nonalcoholic fatty liver disease (NAFLD) is the presence of intracellular fat deposition in more than 5% of hepatocytes without excessive alcohol consumption, another disease that will cause fatty liver, a history of operation or drug use. Nonalcoholic fatty liver disease is the most common cause of liver transplantation in the United States, after hepatitis C (HCV) virus-induced liver cirrhosis. Epicardial adipose tissue (EAT), as a special form of visceral adipose tissue accumulating around the heart, has metabolic, thermogenic (as brown fat) and mechanical (cardioprotective) properties under physiological conditions. Epicardial adipose tissue thickness (EATT) and volume have been associated with visceral fat, coronary artery disease, subclinical atherosclerosis, insulin resistance, metabolic syndrome, and cardiac changes. Epicardial adipose tissue thickness is a parameter associated with the presence and progression of NAFLD. The degree of cardiovascular disease (CVD) risk can be predicted by carotid intima media thickness (CIMT). CIMT can be used to determine the relationship between NAFLD and cardiovascular disease. Since atherosclerosis affects all arterial structures, the choice of peripheral arteries is more comfortable in the follow-up and treatment. Increased arterial stiffness can reduce flow propagation velocity with increased flow resistance. Based on this, aortic propagation velocity (APV) can be used to determine arterial stiffness as a simple, non-invasive and reproducible technique. There is an inverse correlation between aortic propagation velocity and the severity of coronary artery disease. In addition, a relationship has been found between APV and CIMT. Objective: The aim of the study is to determine whether there is a relationship between NAFLD and EATT, CIMT and AVP. There are not enough noninvasive parameters to show the relationship between nonalcoholic fatty liver disease and the risk of atherosclerosis and cardiovascular disease. The parameters we studied are also the parameters associated with atherosclerosis. The study was planned as descriptive. Our study included 216 patients over the age of 18 who presented to the internal medicine clinic of Erzincan Binali Yıldırım University Faculty of Medicine Mengücek Gazi Training and Research Hospital for routine control and performed blood tests and abdominal ultrasonography (USG). 4 Materials and Methods: Age, gender, EATT, CIMT, APV, NAFLD Fibrosis Score, body mass index (BMI), waist and hip circumference, systolic and diastolic blood pressure, mitral E/A ratio, aortic strain, aortic distensibility, aortic stiffness index and some laboratory parameters of the individuals participating in the study were compared. Results: According to the data obtained, the mean EATT of individuals without hepatosteatosis was 3.9±0.8 mm, while the mean of those with hepatosteatosis was 5.1±0.7 mm, and a significant difference was found between the two groups (p<0.001). The mean CIMT of individuals without hepatosteatosis was 0.82±0.12 mm, and this value was found to be 1.01±0.12 mm in patients with hepatosteatosis. (p<0.001). While the mean APV of individuals without hepatosteatosis was 56.4±7.9 cm/sec, the mean APV of those with hepatosteatosis was 43.8±7.9 cm/sec (p<0.001). When the demographic characteristics of the groups with and without hepatosteatosis were compared, a statistically significant difference was found between waist and hip circumference, systolic and diastolic blood pressure, BMI, NAFLD fibrosis score, aortic distensibility, aortic stiffness index, and aortic strain values. When the laboratory tests of the groups were compared, there was a significant difference between glucose, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT) and uric acid values. Considering the degrees of hepatosteatosis, a significant difference was found between the groups' BMI, waist circumference, hip circumference, blood pressure, NAFLD fibrosis score, aortic distensibility, CIMT, EATT, aortic strain, aortic stiffness, APV, and triglyceride values. In the regression analysis, it was determined that an increase in BMI increased hepatosteatosis 1.29 times, and an increase in EAT increased hepatosteatosis 5.49 times. Conclusion: A significant correlation was found between NAFLD and CIMT, EATT and APV. BMI and EATT were determined as parameters predicting NAFLD. NAFLD causes increased risk of liver cirrhosis and HCC. In addition, NAFLD is known to be associated with atherosclerosis and CVD. Therefore, early diagnosis and treatment is important. It may be useful to evaluate patients with NAFLD diagnosis in terms of atherosclerosis and CVD risk with parameters such as EATT, CIMT and APV, which are noninvasive methods.