Association of Non-alcoholic Fatty Liver Disease with Conduction Defects on Electrocardiogram

Mangi, Muhammad Asif; Minhas, Abdul Mannan Khan; Rehman, Hiba; Pathan, Furquan; Hong, Liang; Beidas, Sary

doi:10.7759/cureus.1107

Cited by 14 publications

(29 citation statements)

References 29 publications

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“…One article was excluded due to the presence of alcoholic hepatic steatosis and another one was excluded as the full article was not found. We finally analysed 20 papers [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

“…The two studies evaluating QTc interval in NAFLD, both being rated as "good" supported that prolonged QTc interval is independently associated with the severity of NAFLD [22,24]. Moreover, out of the fours studies that evaluated cardiac conduction abnormalities in NAFLD and supported this association, two were rated as "good" [13,14], one was rated as "fair" [27], and one as "poor" [18]. Furthermore, IHD findings evaluated by ECG in NAFLD patients was evaluated in two studies.…”

Section: Supplementary Table I Nhlbi Quality Assessment Tool For Obsmentioning

confidence: 92%

“…The diagnosis of NAFLD using abdominal ultrasonography is usually performed by assessing the echogenicity of the liver in comparison to that of the right kidney and the diaphragm (31). In our review, most studies used ultrasonography for diagnosing NAFLD (n=13) [11,13,[18][19][20][21][22][23][24][25][26][27]29], while others used both ultrasonography and elastography (n=2) [10,16], CT (n=2) [15,28], either CT or ultrasonography (n=1) [14], either ICD-9 code or biopsy (n=1) [12] and 1 used FLI [17]. Cardiac Arrhythmias A total of 12 studies assessed the association of NAFLD and cardiac arrhythmias (Table I).…”

Section: Definition Of Nafldmentioning

confidence: 99%

“…A total of 3 cross-sectional studies and 1 case-control study evaluated the relationship between NAFLD and cardiac conduction abnormalities (Table III) [13,14,18,27].…”

Section: Cardiac Conduction Abnormalitiesmentioning

confidence: 99%

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Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Ismaiel

Colosi

Rusu

et al. 2019

JGLD

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Background and Aims: Recent studies have evaluated the relationship associating non-alcoholic fatty liver disease (NAFLD) with several electrocardiogram (ECG) findings, but the results have been inconsistent. The aim of this systematic review is to assess the association between NAFLD with ECG modifications. Methods: We conducted a systematic search on PubMed with predefined keywords identifying observational studies published till 22 February 2019 with NAFLD diagnosed either by biopsy, imaging, surrogate markers or ICD code and ECG findings by either a standard ECG, 24-hour Holter ECG or ICD code. Quality assessment was performed using the quality assessment tools from the National Heart, Lung, and Blood Institute. Results: A total of 20 observational studies (1 case-control, 4 cohort, 15 cross-sectional studies, 401,745 individuals) were included. Twelve studies evaluated cardiac arrhythmias in NAFLD subjects, out of which 10 evaluated atrial fibrillation (AF). Although results were inconsistent, most studies rated as “good” demonstrated that hepatic steatosis was independently associated with an increased risk for prevalent AF in NAFLD patients. Diabetic patients with NAFLD were associated with an increased risk of ventricular arrhythmias in only one study rated as “good”. Two studies rated as “good” demonstrated that hepatic steatosis was associated with a prolonged QTc interval. Four studies supported the association between cardiac conduction abnormalities and NAFLD, out of which two were rated as “good”. Two studies assessed ECG modifications of ischemic heart disease (IHD), but only one having a “good” rating confirmed this independent association. Conclusions: Studies of high quality and with low risk of bias demonstrated that NAFLD is independently associated with AF, a prolonged QTc interval, bundle branch and atrioventricular blocks. Diabetic patients with NAFLD present an increased risk for developing ventricular arrhythmias.

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Section: Resultsmentioning

confidence: 99%

Section: Supplementary Table I Nhlbi Quality Assessment Tool For Obsmentioning

confidence: 92%

Section: Definition Of Nafldmentioning

confidence: 99%

“…A total of 3 cross-sectional studies and 1 case-control study evaluated the relationship between NAFLD and cardiac conduction abnormalities (Table III) [13,14,18,27].…”

Section: Cardiac Conduction Abnormalitiesmentioning

confidence: 99%

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Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Ismaiel

Colosi

Rusu

et al. 2019

JGLD

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“…In particular, several epidemiological studies have suggested that NAFLD is strongly associated with an increased risk of permanent atrial fibrillation, heart rate-corrected QT interval prolongation and ventricular tachyarrhythmias both in patients with and without T2DM [ 8 – 13 ]. To date, only one retrospective case-control study has ascertained the association between NAFLD and heart block, demonstrating that NAFLD is closely associated with the presence of cardiac conduction defects in a hospital-based sample of 700 adult patients (about 30% of them had known T2DM) admitted to the Orange Park Medical Center in Florida from 2009 to 2015 [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus

et al. 2017

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Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiac tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus. The aim of this study was to examine whether an association also exists between NAFLD and heart block. We have retrospectively evaluated a hospital-based cohort of 751 patients with type 2 diabetes discharged from our Division of Diabetes and Endocrinology during years 2007–2014. Standard electrocardiograms were performed on all patients. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced hepatic fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis markers. Overall, 524 (69.8%) patients had NAFLD and 202 (26.9%) had heart block (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block) on electrocardiograms. Patients with NAFLD had a remarkably higher prevalence of any persistent heart block than those without NAFLD (31.3% vs. 16.7%, p<0.001); this prevalence was particularly increased among those with higher FIB-4 score. NAFLD was associated with a threefold increased risk of prevalent heart block (adjusted-odds ratio 3.04, 95% CI 1.81–5.10), independently of age, sex, hypertension, prior ischemic heart disease, hemoglobin A1c, microvascular complication status, use of medications and other potentially confounding factors. In conclusion, this is the largest cross-sectional study to show that NAFLD and its severity are independently associated with an increased risk of prevalent heart block in hospitalized patients with type 2 diabetes.

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Impact of different ectopic fat depots on cardiovascular and metabolic diseases

Ferrara

Montecucco

Dallegri

2019

Journal Cellular Physiology

148

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A growing body of evidence is pointing out the pathophysiological role of fat accumulation in different organs. Ectopic fat depots within heart, liver, skeletal muscle, kidney, and pancreas as well as around blood vessels might be more associated to cardiometabolic risk than classical variables, such as body mass index.Among different mechanisms, lipid metabolism appears to be particularly influenced by ectopic fat depots. Indeed, intracellular accumulation of nonesterified fatty acids, and triglycerides promotes endoplasmic reticulum stress, mitochondrial uncoupling, oxidative stress, and altered membrane composition/function, finally promoting inflammatory response and cell death. The dysfunctional adipose tissue was shown to induce both local and systemic effects, with relevant clinical consequences. Epicardial fat and myocardial steatosis have been associated with the development of atrial fibrillation and ventricular dysfunction. Similarly perivascular adipose tissue appears to trigger atherosclerosis and hypertension. Nonalcoholic fatty liver disease has been recognized both as the hepatic manifestation of metabolic syndrome and as a cardiovascular (CV) risk factor. Importantly, the renal sinus fat emerged as a potential player in kidney dysfunction. Finally, both skeletal muscle and pancreatic fat depots have been indicated as potential endocrine modulators of insulin resistance.Considering the global rise in the prevalence of obesity, the understanding of mechanisms underlying ectopic fat accumulation represents an urgent need, with potential clinical implications for CV risk stratification. Here, we attempt to update the current knowledge of the different ectopic fat depots, focusing on underlying mechanisms and potential clinical implications.

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Association of Non-alcoholic Fatty Liver Disease with Conduction Defects on Electrocardiogram

Cited by 14 publications

References 29 publications

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus

Impact of different ectopic fat depots on cardiovascular and metabolic diseases

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