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

Abstract

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.

Prediction of biological age and all-cause mortality by 12-lead electrocardiogram in patients without structural heart disease

“…21 ECG, which can be performed readily and repeatedly, and can be analyzed instantly, could be a candidate of a tool for predicting BA, because ECG parameters would vary according to individual age and gender. 5,6 Although ECG is mainly responsible for the circulatory and the respiratory system, several analyses have revealed that ECG can be affected by various extracardiac diseases: ventricular repolarization was altered by hemodialysis 22 ; prolonged QTc was observed in end-stage liver disease 23,24 and non-alcoholic fatty liver disease 25 ; ST segment and T wave can be altered in acute cholecystitis 26 ; ST depression, left ventricular hypertrophy, prolonged QTc, and T wave inversion were observed in patients with intracranial hemorrhage 27,28 and other ECG abnormalities were represented in patients with brain injury and stroke 27 ; higher heart rate, prolonged QTc, and low voltage appeared in patients with thyroid dysfunction. 29 The possible common mechanisms which connects the various systemic health status and ECG would be vascular status and autonomic nerve system, which would possibly be the key pathogenesis that accords aging.…”

Acute Coronary Syndromes and Nonalcoholic Fatty Liver Disease: “Un Affaire de Coeur”

“…NAFLD is a multisystem complex pathology without current approved therapies, primarily affecting the liver which causes modifications to the structure and function of the liver, leading to an increased liver-related morbidity and mortality from cirrhosis, liver failure, and hepatocellular carcinoma [5][6][7]. Moreover, an increasing body of evidence supports that NAFLD is not only a progressive liver disease, but can also lead to multiple systemic consequences and extrahepatic manifestations, including effects exerted on the cardiovascular system (CVS) [8][9][10][11].…”

Nonalcoholic fatty liver disease, a potential risk factor of non-specific ST-T segment changes: data from a cross-sectional study

“…Our findings suggested that the NST changes might represent an additional correlation with higher CVD risk in patients with NAFLD, and emphasized the importance of evaluating arrhythmic risk in NAFLD patients so as to strengthen early prevention and early intervention of CVD. Previous studies have demonstrated that there existed significant correlation between NAFLD and cardiac arrhythmias (Ismaiel et al, 2019), such as QTc prolongation (Targher et al, 2014), atrial fibrillation (Anstee et al, 2018), ventricular arrhythmias (Mantovani et al, 2016), but little attention was paid to explore the relationship between NST and NAFLD. Although, it has been suggested that NAFLD have adverse impact on ST segment elevation in myocardial infarction (Emre et al, 2015;Keskin et al, 2017) and NAFLD was correlated with silent myocardial ischemia (Lee et al, 2006), NST changes may be earlier signs of cardiovascular changes (Healy & Lloyd-Jones, 2016).…”