{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:43:13Z","timestamp":1785775393037,"version":"3.56.0"},"reference-count":79,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University Of Medicine And Pharmacy Timisoara, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Heart failure is associated with high morbidity and mortality and linked with several pre-existing health conditions and risk factors. Early detection and prompt management in heart failure improves patient outcomes. Liver involvement is associated with heart failure disease progression, and hence liver biomarkers and liver fibrosis may have a prognostic impact. Several blood test based markers and scoring systems estimate liver fibrosis and hence can be useful prognostic tools. Materials and Methods: We retrospectively analyzed a series of 303 patients with decompensated heart failure in a city in western Romania over a period of 6 months. Several biochemical parameters were measured, the FIB-4 score was estimated and echocardiography was performed. Results for targeted variables are presented using descriptive statistics. Patients were analyzed based on their LVEF categories. Statistical analysis was based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables. Pairwise comparisons were performed based on Bonferroni adjusted significance tests. The correlations between FIB-4 score, LVEF and NT-pro BNP in patients with and without diabetes and hypertension were explored using Spearman\u2019s correlation coefficient. Result: Age, gender, NYHA class, death, history of (h\/o) type 2 diabetes mellitus (T2DM), h\/o coronary artery disease (CAD), h\/o arrhythmias, sodium, potassium, creatinine, eGFR, uric acid, NT-pro BNP, left atrial volume, LDL, HDL, and TG were analyzed by LVEF categories using ANOVA one-way tests, Chi-square tests, and Bonferroni correction comparisons. We found a strong statistically significant correlation between each of NT-pro BNP, left atrial volume, LDL, and HDL with the LVEF categories. Discussion: Early detection of cardiac dysfunction leads to better management in patients with cardiovascular risk factors including diabetes and hypertension. High LDL and low HDL levels contribute to a reduction in left ventricular (LV) function. Available literature suggests the FIB-4 score as superior to other non-invasive markers of fibrosis. It utilizes the patient\u2019s age, platelet count, AST, and ALT, which can be available retrospectively, making it an easy and inexpensive tool. FIB-4 score has a few limitations. Conclusions: Our study has shown a statistically significant positive correlation between severity categories of LVEF and FIB-4 score for heart failure patients with and without diabetes, and for heart failure patients with or without hypertension. We propose the implementation of FIB-4 score as a prognostic tool for heart failure.<\/jats:p>","DOI":"10.3390\/medicina60121943","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T04:02:18Z","timestamp":1732593738000},"page":"1943","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Correlation of the FIB-4 Liver Biomarker Score with the Severity of Heart Failure"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7476-6584","authenticated-orcid":false,"given":"Roxana","family":"Buzas","sequence":"first","affiliation":[{"name":"1st Medical Semiology, Internal Medicine, Department V, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Ciubotaru","sequence":"additional","affiliation":[{"name":"1st Medical Semiology, Internal Medicine, Department V, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Corina","family":"Faur","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy Timi\u0219oara, Eftimie Murgu Square, No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7792-8171","authenticated-orcid":false,"given":"Marius","family":"Preda","sequence":"additional","affiliation":[{"name":"Second Discipline of Surgical Semiology, Department IX\u2014Surgery\u20141, \u201cVictor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania"},{"name":"Breast Surgery Research Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melania","family":"Ardelean","sequence":"additional","affiliation":[{"name":"1st Medical Semiology, Internal Medicine, Department V, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina","family":"Georgescu","sequence":"additional","affiliation":[{"name":"1st Medical Semiology, Internal Medicine, Department V, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Dumitrescu","sequence":"additional","affiliation":[{"name":"General Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy from Timi\u0219oara, Eftimie Murgu Sq. No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Florin","family":"Lighezan","sequence":"additional","affiliation":[{"name":"1st Medical Semiology, Internal Medicine, Department V, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela-Diana","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Microbiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3068","DOI":"10.1161\/01.CIR.0000039105.49749.6F","article-title":"Lifetime risk for developing congestive heart failure: The Framingham Heart Study","volume":"106","author":"Larson","year":"2002","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s00392-014-0788-x","article-title":"Sex differences in new-onset heart failure","volume":"104","author":"Meyer","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/eurheartj\/eht066","article-title":"Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND","volume":"34","author":"Brouwers","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1161\/CIRCRESAHA.113.300268","article-title":"Epidemiology of heart failure","volume":"113","author":"Roger","year":"2013","journal-title":"Circ. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/hrt.2003.025270","article-title":"Clinical epidemiology of heart failure","volume":"93","author":"Mosterd","year":"2007","journal-title":"Heart"},{"key":"ref_7","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_8","first-page":"237","article-title":"The causes, consequences, and treatment of left or right heart failure","volume":"7","year":"2011","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.3909\/ricm0602","article-title":"Contribution of right ventricular dysfunction to heart failure mortality: A meta-analysis","volume":"13","author":"Garrote","year":"2012","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/ejhf.1029","article-title":"Right heart dysfunction and failure in heart failure with preserved ejection fraction: Mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology","volume":"20","author":"Gorter","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.amjmed.2009.04.022","article-title":"Risk factors for heart failure: A population-based case-control study","volume":"122","author":"Dunlay","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sharma, A., Christodorescu, R., Agbariah, A., Duda-Seiman, D., Dahdal, D., Man, D., Kundnani, N.R., Cretu, O.M., and Dragan, S. (2022). Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases. Healthcare, 10.","DOI":"10.3390\/healthcare10020312"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rosca, C.I., Lighezan, D.F., Nisulescu, D.-D., Sharma, A., Neagu, M.N., Nistor, D., Georgescu, D., and Kundnani, N.R. (2023). Metabolic Syndrome: A Strange Companion of Atrial Fibrillation; A Blessing in Disguise from the Neuropsychiatric Point of View. Biomedicines, 11.","DOI":"10.3390\/biomedicines11072012"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/S1089-3261(02)00056-9","article-title":"The liver in heart failure","volume":"6","author":"Giallourakis","year":"2002","journal-title":"Clin. Liver Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jchf.2018.10.007","article-title":"Heart Failure and Liver Disease: Cardiohepatic Interactions","volume":"7","author":"Xanthopoulos","year":"2019","journal-title":"JACC Heart Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1002\/hep.26643","article-title":"Serum B-type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study","volume":"59","author":"Farias","year":"2014","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1002\/hep.30048","article-title":"Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy","volume":"68","author":"Lemmer","year":"2018","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.numecd.2018.07.005","article-title":"Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies","volume":"28","author":"Aune","year":"2018","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1007\/s00125-019-4926-x","article-title":"Diabetes as a risk factor for heart failure in women and men: A systematic review and meta-analysis of 47 cohorts including 12 million individuals","volume":"62","author":"Ohkuma","year":"2019","journal-title":"Diabetologia"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rosca, C.I., Branea, H.S., Sharma, A., Nicoras, V.A., Borza, C., Lighezan, D.F., Morariu, S.I., and Kundnani, N.R. (2023). Rhythm Disturbances in Post-Acute COVID-19 Syndrome in Young Men without Pre-Existing Known Cardiovascular Disease\u2014A Case Series. Biomedicines, 11.","DOI":"10.3390\/biomedicines11041146"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Duda-Seiman, D., Kundnani, N.R., Dugaci, D., Man, D.E., Velimirovici, D., and Dragan, S.R. (2022). COVID-19 Related Myocarditis and Myositis in a Patient with Undiagnosed Antisynthetase Syndrome. Biomedicines, 11.","DOI":"10.3390\/biomedicines11010095"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1159\/000521808","article-title":"COVID-19 and the Human Eye: Conjunctivitis, a Lone COVID-19 Finding\u2014A Case-Control Study","volume":"31","author":"Mocanu","year":"2022","journal-title":"Med. Princ. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100271","DOI":"10.1016\/j.ahjo.2023.100271","article-title":"Retrospective analyses of the outcomes among hospitalized liver cirrhosis patients with heart failure and COVID-19 infection: Insight from the National Inpatient Sample","volume":"27","author":"Casipit","year":"2023","journal-title":"Am. Heart J. Plus Cardiol. Res. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1038\/s41392-024-01796-2","article-title":"Infection with SARS-CoV-2 can cause pancreatic impairment","volume":"9","author":"Deng","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"151551","DOI":"10.1172\/jci.insight.151551","article-title":"SARS-CoV-2 infection of the pancreas promotes thrombofibrosis and is associated with new-onset diabetes","volume":"6","author":"Qadir","year":"2021","journal-title":"JCI Insight"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/j.cmet.2021.05.015","article-title":"SARS-CoV-2 infection induces beta cell transdifferentiation","volume":"33","author":"Tang","year":"2021","journal-title":"Cell Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.cmet.2021.05.013","article-title":"SARS-CoV-2 infects human pancreatic \u03b2 cells and elicits \u03b2 cell impairment","volume":"33","author":"Wu","year":"2021","journal-title":"Cell Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3534","DOI":"10.1038\/s41467-021-23886-3","article-title":"Viral infiltration of pancreatic islets in patients with COVID-19","volume":"12","author":"Steenblock","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1053\/j.gastro.2015.04.043","article-title":"Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease","volume":"149","author":"Angulo","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1002\/hep.29085","article-title":"Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis","volume":"65","author":"Dulai","year":"2017","journal-title":"Hepatology"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zhang, J., Xu, M., Chen, T., and Zhou, Y. (2021). Correlation Between Liver Stiffness and Diastolic Function, Left Ventricular Hypertrophy, and Right Cardiac Function in Patients With Ejection Fraction Preserved Heart Failure. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.748173"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1253\/circj.CJ-15-1200","article-title":"Value of Virtual Touch Quantification Elastography for Assessing Liver Congestion in Patients with Heart Failure","volume":"80","author":"Yoshitani","year":"2016","journal-title":"Circ. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.amjcard.2013.10.018","article-title":"Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure","volume":"113","author":"Taniguchi","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1253\/circj.CJ-17-1344","article-title":"Prognostic Relevance of Liver Stiffness Assessed by Transient Elastography in Patients with Acute Decompensated Heart Failure","volume":"82","author":"Saito","year":"2018","journal-title":"Circ. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1002\/ejhf.2649","article-title":"Liver tests and outcomes in heart failure with reduced ejection fraction: Findings from DAPA-HF","volume":"24","author":"Adamson","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1002\/ehf2.13878","article-title":"Type III procollagen peptide level can indicate liver dysfunction associated with volume overload in acute heart failure","volume":"9","author":"Shirakabe","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20587384211051955","DOI":"10.1177\/20587384211051955","article-title":"Benefits of prescribing low-dose digoxin in atrial fibrillation","volume":"35","author":"Rosca","year":"2021","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.cmet.2018.01.007","article-title":"Digoxin Suppresses Pyruvate Kinase M2-Promoted HIF-1\u03b1 Transactivation in Steatohepatitis","volume":"27","author":"Ouyang","year":"2018","journal-title":"Cell Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1080\/00365521.2023.2239974","article-title":"Impact of concomitant cardiovascular medications on overall survival in patients with liver cirrhosis","volume":"58","author":"Li","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_40","first-page":"309","article-title":"Prognostic significance of brain-derived neurotrophic factor levels in patients with heart failure and reduced left ventricular ejection fraction","volume":"22","author":"Barman","year":"2019","journal-title":"Anatol. J. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jneuroim.2011.06.015","article-title":"Differential effect of clopidogrel and aspirin on the release of BDNF from platelets","volume":"238","author":"Stoll","year":"2011","journal-title":"J. Neuroimmunol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1038\/mp.2013.105","article-title":"Serum BDNF concentrations as peripheral manifestations of depression: Evidence from a systematic review and meta-analyses on 179 associations (N = 9484)","volume":"19","author":"Molendijk","year":"2014","journal-title":"Mol. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jpsychires.2006.01.014","article-title":"BDNF serum and CSF concentrations in Alzheimer\u2019s disease, normal pressure hydrocephalus and healthy controls","volume":"41","author":"Laske","year":"2007","journal-title":"J. Psychiatr. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.healun.2012.02.027","article-title":"Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system","volume":"31","author":"Yang","year":"2012","journal-title":"J. Heart Lung Transplant."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1097\/PAS.0000000000001250","article-title":"Validation of a Congestive Hepatic Fibrosis Scoring System","volume":"43","author":"Bosch","year":"2019","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3809","DOI":"10.1002\/ehf2.13351","article-title":"Prognostic significance of liver stiffness assessed by fibrosis-4 index in patients with heart failure","volume":"8","author":"Takae","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Yang, K., and Song, M. (2023). New Insights into the Pathogenesis of Metabolic-Associated Fatty Liver Disease (MAFLD): Gut-Liver-Heart Crosstalk. Nutrients, 15.","DOI":"10.3390\/nu15183970"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1002\/ehf2.13829","article-title":"Prognostic value of the liver fibrosis marker fibrosis-5 index in patients with acute heart failure","volume":"9","author":"Maeda","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_50","first-page":"861","article-title":"Characterization of the Effects of Two Polyphenols-Rich Plant Extracts on Isolated Diabetic Human Mammary Arteries","volume":"65","author":"Badalica","year":"2014","journal-title":"Rev. Chim."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1089\/met.2008.0034","article-title":"The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects","volume":"6","year":"2008","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4239\/wjd.v1.i2.36","article-title":"Surrogate markers of insulin resistance: A review","volume":"1","author":"Singh","year":"2010","journal-title":"World J. Diabetes"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"108786","DOI":"10.1016\/j.diabres.2021.108786","article-title":"The prognostic value of the triglyceride glucose index in patients with chronic heart failure and type 2 diabetes: A retrospective cohort study","volume":"177","author":"Guo","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1093\/eurjpc\/zwac058","article-title":"Triglyceride-glucose index in the development of heart failure and left ventricular dysfunction: Analysis of the ARIC study","volume":"29","author":"Huang","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Cho, Y.R., Ann, S.H., Won, K.B., Park, G.M., Kim, Y.G., Yang, D.H., Kang, J.W., Lim, T.H., Kim, H.K., and Choe, J. (2019). Association between insulin resistance, hyperglycemia, and coronary artery disease according to the presence of diabetes. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-42700-1"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12933-022-01511-x","article-title":"Triglyceride-glucose index as a marker in cardiovascular diseases: Landscape and limitations","volume":"21","author":"Tao","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1038\/s41440-020-0427-z","article-title":"Cardiovascular risk profile and frailty in Japanese outpatients: The Nambu Cohort Study","volume":"43","author":"Matsuoka","year":"2020","journal-title":"Hypertens Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1093\/ejechocard\/jep097","article-title":"Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: Correlation with diabetic duration","volume":"10","author":"Nakai","year":"2009","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1093\/ehjci\/jeac118","article-title":"Regional longitudinal strain patterns according to left ventricular hypertrophy in the general population","volume":"23","author":"Olsen","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1161\/01.CIR.0000036014.90197.FA","article-title":"Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications","volume":"106","author":"Bolognese","year":"2002","journal-title":"Circulation"},{"key":"ref_61","first-page":"e1162","article-title":"Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology","volume":"139","author":"Braun","year":"2019","journal-title":"Circulation"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1161\/01.CIR.101.25.2981","article-title":"Left ventricular remodeling after myocardial infarction: Pathophysiology and therapy","volume":"101","author":"Sutton","year":"2000","journal-title":"Circulation"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1161\/01.CIR.84.5.1984","article-title":"Endothelial dysfunction of the coronary microvasculature is associated with coronary blood flow regulation in patients with early atherosclerosis","volume":"84","author":"Zeiher","year":"1991","journal-title":"Circulation"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0021-9150(99)00108-2","article-title":"The effects of dyslipidemia on left ventricular systolic function in patients with stable angina pectoris","volume":"146","author":"Wang","year":"1999","journal-title":"Atherosclerosis"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Mayala, H.A., Mafuru, M., Mkangala, A., Mayala, M., Pallangyo, P., Minja, D., Janabi, M., and Zhao-Hui, W. (2020). Factors influencing left ventricular ejection fraction in patients with coronary microvascular disease and obstructive coronary artery disease. BMC Res. Notes, 13.","DOI":"10.1186\/s13104-020-05008-2"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4070\/kcj.2011.41.3.124","article-title":"Dyslipidemia, low left ventricular ejection fraction and high wall motion score index are predictors of progressive left ventricular dilatation after acute myocardial infarction","volume":"41","author":"Yoon","year":"2011","journal-title":"Korean Circ. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/j.1478-3231.2009.02192.x","article-title":"Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients","volume":"30","author":"Kim","year":"2010","journal-title":"Liver Int."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.cgh.2009.05.033","article-title":"Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease","volume":"7","author":"Shah","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Sumida, Y., Yoneda, M., Hyogo, H., Itoh, Y., Ono, M., Fujii, H., Eguchi, Y., Suzuki, Y., Aoki, N., and Kanemasa, K. (2012). Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol., 12.","DOI":"10.1186\/1471-230X-12-2"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C","volume":"38","author":"Wai","year":"2003","journal-title":"Hepatology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1046\/j.1365-2893.1997.00141.x","article-title":"Age and platelet count: A simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups","volume":"4","author":"Poynard","year":"1997","journal-title":"J. Viral Hepat."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1572-0241.1998.044_c.x","article-title":"AST\/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection","volume":"93","author":"Sheth","year":"1998","journal-title":"Am. J. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1111\/j.1572-0241.2001.05268.x","article-title":"Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection","volume":"96","author":"Pohl","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1053\/j.gastro.2004.10.012","article-title":"Assessing fibrosis without a liver biopsy: Are we there yet?","volume":"127","author":"Bissell","year":"2004","journal-title":"Gastroenterology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"100780","DOI":"10.1016\/j.lanepe.2023.100780","article-title":"Prognostic utility of Fibrosis-4 Index for risk of subsequent liver and cardiovascular events, and all-cause mortality in individuals with obesity and\/or type 2 diabetes: A longitudinal cohort study","volume":"36","author":"Anstee","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Kamada, Y., Munekage, K., Nakahara, T., Fujii, H., Sawai, Y., Doi, Y., Hyogo, H., Sumida, Y., Imai, Y., and Miyoshi, E. (2022). The FIB-4 Index Predicts the Development of Liver-Related Events, Extrahepatic Cancers, and Coronary Vascular Disease in Patients with NAFLD. Nutrients, 15.","DOI":"10.3390\/nu15010066"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1038\/ajg.2016.453","article-title":"Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis","volume":"112","author":"McPherson","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/S0002-9149(02)02886-2","article-title":"Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation","volume":"90","author":"Lau","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1002\/ehf2.14336","article-title":"Comparison of liver fibrosis scores for predicting mortality and morbidity in heart failure with preserved ejection fraction","volume":"10","author":"Cao","year":"2023","journal-title":"ESC Heart Fail."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/1943\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:39:33Z","timestamp":1760114373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/1943"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":79,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["medicina60121943"],"URL":"https:\/\/doi.org\/10.3390\/medicina60121943","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]}}}