studies

1292A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
The following authors have nothing to disclose: Leonardo A. Martinez Rodriguez,
Aldo Torre, David Kershenobich
2224
The association of ALT levels with myocardial perfusion
imaging and cardiovascular morbidity
David Yardeni 2 , Ohad Etzion 1,3 , Ronen Toledano 4 , Victor
Novack 4 , Aryeh Shalev 5 , Arik Wolak 5 , Yaron Rotman 1 ; 1 Liver Disease
Branch, NIH, Rockville, MD; 2 Internal Medicine Division,
Soroka University Medical Center, Beer-Sheva, Israel; 3 Gastroenterology
and Liver disease, Soroka University Medical Center,
beer-Sheva, Israel; 4 Clinical Research Center, soroka University
Medical Center, Beer-Sheva, Israel; 5 Department of Cardiology,
Soroka University Medical Center, beer-Sheva, Israel
Background and aims: There is a growing body of evidence
suggesting that non-alcoholic fatty liver disease (NAFLD) is
associated with an independent increased risk of cardiovascular
disease (CVD) beyond that is conferred by the metabolic
syndrome. We utilized a large cohort of patients undergoing
myocardial perfusion imaging (MPI) with single photon emission
computed tomography (SPECT) to determine the association
between alanine aminotransferase (ALT) as a surrogate
marker for NAFLD,and the presence of myocardial ischemia as
well as the effects of ALT on mortality in patients with and without
ischemia. Methods: We retrospectively assessed SPECT-MPI
and laboratory test results, prescriptions and clinical diagnoses,
extracted from the electronic medical records of all individuals
who underwent SPECT MPI at Soroka University Medical
Center between 1997 and 2008. We excluded patients with
viral hepatitis, positive autoimmune markers, ALT values 340 u/L, and absent liver tests within 1 year prior or
following SPECT MPI. Cases with elevated ALT were classified
as presumed NAFLD. The primary outcome was abnormal myocardial
perfusion, defined as >1% perfusion defect. Secondary
outcomes were a composite cardiac outcome of cardiac death
or acute myocardial infarction 3 and 5 years following SPECT-
MPI, and all-cause mortality Results: Of 26,028 patients who
underwent SPECT-MPI, 11,582 met inclusion criteria and were
included in the final analysis. 1,704 (14.7%) patients had elevated
ALT within a year of SPECT-MPI. Patients with abnormal
ALT were younger and included significantly more males and
smokers (p < 0.001 for all). Dyslipidemia, diabetes mellitus,
obesity and congestive heart failure were also more common
in the elevated ALT group. SPECT-MPI results did not differ
between subjects with elevated ALT and controls. Elevated ALT
was associated with increased risk for the composite outcome
of cardiac death or acute myocardial infarction at 3-year follow-up,
HR, 1.46 (95% CI 1.07–1.99) and in all cause mortality
(HR. 1.69, CI (1.28–2.23) but only in patients with normal
SPECT-MPI. At 5-years follow-up ALT levels were not associated
with the composite outcome or all-cause mortality. Conclusions:.
The long-term mortality of patients with abnormal SPECT-MPI is
not modulated by ALT, likely reflecting an already high risk and
established advanced atherosclerotic process. On the other
hand, patients with normal SPECT-MPI are at increased risk for
a future cardiac event if they have an elevated ALT level, suggesting
an important role for NAFLD in earlier stages of CVD.
Our results highlight the complex interaction between NAFLD
and ischemic heart disease.
Disclosures:
The following authors have nothing to disclose: David Yardeni, Ohad Etzion,
Ronen Toledano, Victor Novack, Aryeh Shalev, Arik Wolak, Yaron Rotman
2225
Non-Alcoholic Fatty Liver Disease (NALFD) and Hepatocellular
Carcinoma (HCC), clinical characteristics and
outcome: A single centre experience.
Sum Team Lo, David W. Orr, Adam Barlett, Edward J. Gane; New
Zealand Liver Transplant Unit, Auckland, New Zealand
Aims: To compare patient survival between NAFLD-related
HCC and chronic viral hepatitis-related HCC and to examine
the risk factors and characteristics of NAFLD patients with
HCC. Methods: A retrospective analysis was undertaken at
a national hepatocellular carcinoma (HCC) multidisciplinary
service of all cases of NALFD-related HCCs and matched cases
with chronic viral hepatitis-related HCCs diagnosed between
2001 and 2014. Results: A total of 93 patients with NAFLD-
HCC were diagnosed. These were compared to case-matched
patients with chronic viral hepatitis; HBV or HCV-related HCC
(4:1; n=366). The mean age in NAFLD-HCC was 70.8 and
viral-HCC 58.1 years respectively (p