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INTRODUCTION A hemodynamic derangement in Fontan circulation causes liver pathology known as Fontan‑‑associated liver disease. Although liver biopsy is a standard for diagnosis of liver fibrosis, noninvasive methods are being developed, including shear wave elastography (SWE). OBJECTIVES We aimed to evaluate the degree of liver stiffness (LS) using SWE in patients with Fontan circulation in a long‑‑term follow‑‑up and to investigate a relationship between patient characteristics and LS. PATIENTS AND METHODS The study included 59 patients after the Fontan procedure. Clinical examinations and laboratory tests were performed. According to the stage of LS, patients were divided into 2 subgroups: group 1 (METAVIR stages F1 and F2) and group 2 (METAVIR stages F3 and F4). The ratio of aspartate transaminase to alanine transaminase, aspartate transaminase‑‑to‑‑platelet ratio index (APRI), fibrosis‑‑4 (FIB‑‑4) score, and Forns index were assessed. RESULTS The median LS was 9.1 kPa (interquartile range, 3.9-18.5 kPa). Five patients (9%) demonstrated LS in stage F1; 14 (26%), F2; 28 (52%), F3; and 7 (13%), F4. Group 2 had significantly higher aspartate transaminase and γ‑‑glutamyltranspeptidase levels, APRI, FIB‑‑4, and Forns index, and lower platelet count than group 1. A canonical correlation analysis indicated that LS and thrombocytopenia were related to time from the Fontan procedure, age at procedure, and single ventricular ejection fraction. CONCLUSIONS We showed that adult patients after the Fontan procedure develop liver dysfunction. Time from surgery, age at procedure, and single ventricular ejection fraction are related to the degree of LS assessed by SWE. Finally, SWE, APRI, Forns index, and FIB‑4 score may help assess the degree of liver fibrosis.

Introduction:  Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated., Objectives:  The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms., Patients and Methods:  Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA., Results:  CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049)., Conclusions:  CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques.

We conducted a cross-sectional observation study that included 500 asymptomatic subjects to investigate the relationship between bone metabolism and coronary artery calcification (CAC) in hypertensive conditions. Osteoprotegerin (OPG) and osteopontin (OPN) levels and their associations with hypertension were analyzed to predict CAC in 316 subjects. Multislice computed tomography was used to quantify CAC. Multivariate analysis of variance was used to test the non-interactive effects of hypertension, CAC severity and biomarker levels, and the logistic regression model was applied to predict the risk of CAC. OPG and OPN concentrations were significantly higher in the hypertensive than the normotensive subjects, at 3.0 (2.3-4.0) pmol l(-1) and 51 (21-136) ng ml(-1) vs. 2.4 (2.0-3.0) pmol l(-1) and 41 (13-63) ng ml(-1), respectively. The OPG level, but not OPN level, increased with age (r = 0.29; P = 0.0001). Zero or minimal CAC (<10 Agatston units (AU)) was observed in 63% of the subjects, mild (11-100 AU) in 17%, moderate (101-400 AU) in 12% and severe (401-1000 AU)-to-extensive (>1000 AU) in 8%. In hypertensive subjects, only glomerular filtration rate (GFR) (β = -0.67) and gender (β = 0.52) were significant predictors for CAC (R = 0.68). In normotensive patients, GFR (β = -0.81), gender (β = 0.48) and log-transformed OPG levels (β = 0.15) were significant predictors for CAC. OPG levels were associated with an increased risk of CAC in normotensive subjects only (odds ratio: 3.37; 95% confidence interval (1.63-6.57); P = 0.0002). OPG predicted a premature state of vascular calcification in asymptomatic normotensive individuals, and renal function significantly contributed to this process in both hypertensive and normotensive subjects.

Introduction: It has been shown that formation of denser and poorly lysable fibrin clots is observed in elderly patients with peripheral artery disease (PAD)., Objectives: The aim of the study was to test the hypothesis that premature PAD is associated with more prothrombotic fibrin clot phenotype., Patients and Methods: Ex‑vivo plasma fibrin clot permeability, turbidity, and susceptibility to lysis were evaluated in 31 premature PAD patients (median ankle brachial index [ABI], 0.75; interquartile range, 0.5-0.8) aged 55 or less and 32 PAD patients (ABI, 0.66; 0.56-0.76) aged over 55 years. Subjects without PAD matched for age and sex (n = 40) served as controls., Results: Premature PAD patients were characterized by 32% lower clot permeability (Ks) (P <0.001), 7% longer clot lysis time (t50%) (P = 0.004), and 31% higher maximum D-dimer levels released from fibrin clots (D-Dmax) (P <0.001) compared with controls. These differences remained significant after adjustment for risk factors and medications. None of the fibrin clot parameters differed between premature and older PAD patients. There were correlations between fibrin clot parameters and CRP in premature PAD patients and with ABI in older PAD patients. In a multiple regression model, premature PAD and ABI were independent predictors of Ks, and premature PAD and plasma fibrinogen of the maximum absorbance of a fibrin gel., Conclusions: Plasma fibrin clots show similarly abnormal prothrombotic phenotype in premature and older PAD patients. However, different factors influence fibrin clot parameters in these patient groups. Premature PAD was an independent predictor of clot permeability and maximum absorbance of a fibrin gel.