Cardiac Abnormalities as a New Manifestation of Nonalcoholic Fatty Liver Disease: Echocardiographic and Tissue Doppler Imaging Assessment

Abstract

Nonalcoholic fatty liver disease (NAFLD) is linked to the metabolic syndrome. The aim of the present study is to determine the effect of the metabolic syndrome on left ventricular (LV) geometry and function using as a model patients with NAFLD. Thirty-eight patients with NAFLD, less than 55 years of age and with a normal exercise test, were compared with an age and sex-matched control group. Patients with diabetes mellitus, hypertension, and body mass index>40 were excluded. A complete echocardiographic study including tissue Doppler imaging (TDI) was performed. The following parameters were assessed by echo Doppler: peak velocities of early (E) and late (A) diastolic filling, E/A ratio, flow propagation velocity (Vp). Using TDI early diastolic velocity (E'), and systolic velocity (S') of mitral annulus were obtained. The patients with NAFLD had a significantly higher body mass index (31.4+/-5 vs. 26.4+/-4 kg/m, P=0.01), higher glucose (100.6+/-13 vs. 83.0+/-10 mg/dL, P=0.01), and triglyceride levels (126.5+/-44 vs. 206.5+/-67 mg/dL, P<0.001). Increased thickness of the intraventricular septum, posterior wall (11.03+/-2.2 vs. 8.9+/-2.9 mm, P=0.001; 8.5+/-1.7 vs. 9.7+/-2.3 mm, P=0.04), and larger LV mass and LV mass/height (160.7+/-58.7 vs.115.3+/-35.4 g, P=0.001 and 92.6+/-29.5 vs. 69.2+/-19.8 g/m, P=0.001, respectively) were found in NAFLD group. LV systolic function was similar in both groups. Patients with NAFLD had a lower E (73.6+/-11.0 vs. 86.4+/-20.0 cm/s, P<0.006) and E/A ratio (1.0+/-0.3 vs. 1.76+/-0.8 P<0.0001). Moreover, the Vp and the E' on TDI were significantly lower compared with the control group (49.0+/-9.7 vs. 74.7+/-18.4 cm/s, P<0.0001 and 10.3+/-2.0 vs. 13.8+/-1.7 cm/s, P<0.0001, respectively). On multivariate analysis the E' on TDI was the only independent parameter associated with NAFLD. In conclusion, patients with NAFLD in the absence of morbid obesity, hypertension, and diabetes have mildly altered LV geometry and early features of left ventricular diastolic dysfunction. Early diastolic velocity on TDI was found to be the only index that could identify the patients with NAFLD and metabolic syndrome.

Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: Association with the severity of liver disease

“…Interestingly, after correction for well-known cardiometabolic risk factors (gender, age, visceral obesity, IFG/diabetes and hypertension) severe fibrosis maintained its link not only with the parameters of cardiac geometry (left atrial volume, LVM/H 2.7 , PWT and RWT), but also with the indices of diastolic (lateral TDI e', E/e', E/A ratio) and systolic (EF) function. These results expand previous reports in small cohorts of NAFLD patients [10][11][12][13], reporting a significant impairment in cardiac structure and function, as assessed by echocardiography or MRI, in clinically diagnosed NAFLD patients compared with subjects without fatty liver. Along this line, our results fit with the evidence for an association between liver injury and intima-media thickness [2], another early cardiovascular alteration, also present in NAFLD patients.…”

“…Specifically, studies in small cohorts of subjects at high [10,11] or low [12] cardiometabolic risk highlighted the association of an ultrasonographic diagnosis of NAFLD, after adjustment for metabolic confounders, with a significant impairment in echocardiographic diastolic function compared to non-NAFLD cases. Along this line, a recent study on a small cohort of NAFLD patients reported significant changes in cardiac structure and function as assessed by MRI, in the absence of metabolic changes or overt cardiac disease [13].…”

Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?

“…The main cross-sectional [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and prospective [11,[32][33][34][35][36][37][38][39][40][41][42][43] studies on the association between NAFLD and intermediate markers of CVDor clinical outcomes are shown in Tables 1 and 2 of the Electronic supplementary material. NAFLD, endothelial dysfunction, early carotid atherosclerosis and left ventricular dysfunction NAFLD is associated with circulatory endothelial dysfunction [16,17], a marker of early atherosclerosis. Compared with non-steatotic controls, non-diabetic patients with NAFLD show a significant decrease in brachial artery flow-mediated vasodilation, which is related to the severity of NAFLD histology, independently of age, sex, BMI and HOMA-IR [16].…”

“…Similarly, patients with NAFLD, also in the absence of obesity, hypertension and diabetes, exhibit echocardiographic features of early left ventricular dysfunction [18] and impaired energy metabolism as measured by cardiac 31 P magnetic resonance spectroscopy [19].…”

Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity

“…Considering the influence of liver fat on metabolic health and the association of nonalcoholic fatty liver disease (NAFLD) with features of the metabolic syndrome 24 , others have looked at NAFLD patients and demonstrated subclinical myocardial systolic and diastolic dysfunction in the presence or absence of type 2 diabetes (T2DM) 25,26 .…”