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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015
AFRICA
111
Results
NAFLD was diagnosed in 32 individuals (15 males, 17 females;
mean age 50
±
9 years; 59% with grade I HS, 41% grade II–III
HS) by means of ultrasonography data. Twenty-two individuals
whose ultrasonography data did not show HS comprised the
control group (11 males, 11 females; mean age 50
±
10 years) and
were included in the study.
Clinical characteristics of the 32 NAFLD patients and 22
control subjects are presented in Table 2. Age, gender, body mass
index, diabetes mellitus, dyslipidaemia and smoking status were
similar between the NAFLD patients and controls. Additionally,
there were no significant differences with regard to laboratory
results (Table 2). When compared in terms of echocardiographic
features, the groups were similar in chamber diameter and
standard Doppler parameters (Table 3).
There were no significant differences for E, A, E/A and DT
between the patients and controls. For tissue Doppler parameters,
the Ea and Ea/Aa were lower in the patient group than in the
control group (
p
<
0.001,
p
<
0.001, respectively). Isovolumetric
relaxation time (IVRT) and MPI were significantly higher (
p
=
0.002,
p
<
0.001, respectively) in the patient group. There
were no significant differences for Aa, DTa, Sa, isovolumetric
contraction time (IVCT) and contraction time (CT) between the
two groups. Tissue Doppler parameters are presented in Table 4.
Grade of HS was positively correlated with right ventricular
isovolumetric relaxation time and MPI (
r
=
0.295,
p
=
0.03,
r
=
0.641,
p
<
0.001, respectively). Correlations between grade of HS
and echocardiographic parameters are shown in Table 5.
Table 1. Conventional and tissue Doppler
echocardiographic parameters and their implications
on right ventricular systolic and diastolic function
Parameters
Systolic
function
Diastolic
function
Conventional echocardiography
Tricuspid E
–
+
Tricuspid Aa
–
+
Tricuspid E/A
–
+
Tricuspid E DT
–
+
Tissue Doppler imaging
RV S
′
+
–
RV Ea
′
–
+
RV Aa
′
–
+
RV Ea
′
/Aa
′
–
+
RV deceleration time (ms)
–
+
Isovolumetric relaxation time (ms)
–
+
Isovolumetric contraction time (ms)
+
–
Contraction time (ms)
+
–
Myocardial performance index
+
+
Tricuspid E: peak velocity of early diastolic filling, tricuspid A: peak
velocity of atrial diastolic filling, tricuspid E DT: deceleration time of
early diastolic filling, Ea: tricuspid lateral annulus early diastolic wave,
Aa: tricuspid lateral annulus late diastolic wave, DT: tricuspid lateral
annulus E-wave deceleration time, RV: right ventricular.
Table 2. Demographic and clinical characteristics of the groups
Parameters
Patient
group
(
n
=
32)
Control
group
(
n
=
22)
p-
value
Mean age (years)
50
±
9
51
±
10 0.979
Gender M/F
15/17
11/11
0.821
Body mass index (kg/m²)
29.8
±
3.4 28.2
±
3.2 0.094
Smoking,
n
(%)
5 (15)
7 (31)
0.160
Hypertension,
n
(%)
6 (18)
6 (27)
0.459
Diabetes mellitus
n
(%)
4 (12)
3 (13)
0.903
Dyslipidaemia,
n
(%)
11 (34)
5 (22)
0.357
Glucose (mg/dl)
105.4
±
21.4 102.8
±
28.9
(mmol/l)
5.85
±
1.19 5.71
±
1.60 0.174
AST (U/l)
25.7
±
6.9 25.2
±
7.4 0.711
ALT (U/l)
28.5
±
12.1 26.1
±
12.2 0.459
LDH (U/l)
159.5
±
21.7 156.3
±
17.8 0.672
Haemoglobin (g/dl)
14.1
±
1.1 13.8
±
1.3 0.622
Total cholesterol (mg/dl)
200.7
±
40.3 184.3
±
40.3 0.119
(mmol/l)
5.20
±
1.04 4.77
±
1.04
Triglyceride (mg/dl)
184
±
85.5 158.4
±
77.9 0.189
(mmol/l)
2.08
±
0.97 1.79
±
0.88
High-density lipoprotein (mg/dl)
40
±
8.8 39.5
±
11.2 0.433
(mmol/l)
1.04
±
0.23 1.02
±
0.29
Low-density lipoprotein (mg/dl) 124.7
±
35 113.4
±
35.8 0.144
(mmol/l)
3.23
±
0.91 2.94
±
0.93
AST: aspartate aminotransferase, ALT: alanine transaminase, LDH:
lactate dehydrogenase.
Table 3. Echocardiographic parameters between
the patient group and the control group
Parameters
Patient group
Control group
p-
value
LVEDD (mm)
48.07
±
3.82
48.47
±
3.95 0.986
LVESD (mm)
29.8
±
4.78
30.43
±
4.22 0.140
IVS (mm)
10.08
±
1.33
9.90
±
1.19 0.720
LVEF (%)
68.01
±
7.01
66.31
±
6.59 0.762
RVEDD (mm)
28.78
±
3.15
28.47
±
3.67 0.523
LA diameter (mm)
36.35
±
3.81
36.94
±
3.08 0.710
RA diameter (mm)
32.99
±
4.93
31.31
±
4.72 0.535
Tricuspid E (cm/s)
55.8
±
12.6
54.6
±
8.3
0.888
Tricuspid A (cm/s)
47
±
13
41.7
±
9.6
0.156
Tricuspid E/A ratio
1.2
±
0.4
1.3
±
0.3
0.413
Tricuspid E DT (ms)
190.2
±
30.4
193.6
±
19.5 0.365
LVEDD: left ventricular end-diastolic diameter, LVESD: left ventric-
ular end-systolic diameter, IVS: interventricular septum, LVEF: left
ventricular ejection fraction, RVEDD: right ventricular end-diastolic
diameter, LA: left atrium, RA: right atrium, tricuspid E: peak velocity
of early diastolic filling, tricuspid A: peak velocity of atrial diastolic
filling, tricuspid E DT: deceleration time of early diastolic filling.
Table 4. Right ventricular tissue Doppler
echocardiographic parameters
Parameters
Patient
group
Control
group
p-
value
RV S-wave peak velocity (cm/s)
13.8
±
2.1 14.3
±
2.1 0.476
RV Ea-wave peak velocity (cm/s) 12.1
±
3.1
14
±
3.1 0.03
RV Aa-wave peak velocity (cm/s) 17.2
±
3.6 15.5
±
3.9 0.061
RV Ea/Aa ratio
0.7
±
0.3 0.9
±
0.4 0.02
Ea DT (ms)
166.2
±
27.7 167.2
±
22.7 0.679
IVRT (ms)
77.3
±
8.5 61.5
±
4.3
<
0.001
IVCT (ms)
66.4
±
8.7 62.8
±
9.9 0.072
CT (ms)
295.5
±
27.6 302.1
±
23 5 0.610
Tei index LV
0.50
±
0.05 0.42
±
0.03
<
0.001
RV: right ventricular, Ea: tricuspid lateral annulus early diastolic wave,
Aa: tricuspid lateral annulus late diastolic wave, DT: tricuspid lateral
annulus E-wave deceleration time, IVRT: isovolumetric relaxation
time, IVCT: isovolumetric contraction time, CT: contraction time.