Cardiac Morphology, Function, and Hemodynamics in Patients With Morbid Obesity and Nonalcoholic Steatohepatitis

Abstract

Background The patients with nonalcoholic fatty liver disease demonstrate an increased cardiovascular risk. The adverse influence of liver abnormalities on cardiac function are among many postulated mechanisms behind this association. The aim of the study was to evaluate cardiac morphology and function in patients with morbid obesity referred for bariatric surgery with liver biopsy. Methods and Results We evaluated with echocardiography 171 consecutive patients without known cardiac disease (median age 42 [interquartile range, 37–48] years, median body mass index 43.7 [interquartile range, 41.0–47.5], 67% female patients. Based on the liver biopsy results, there were 44 patients with nonalcoholic steatohepatitis (NASH), 69 patients with isolated steatosis, and 58 patients without steatosis. Patients with NASH demonstrated signs of left ventricular concentric remodeling and hyperdynamic circulation, including indexed left ventricular end‐diastolic diameter [cm/m 2 ]: NASH 1.87 [0.22]; isolated steatosis 2.03 [0.33]; without steatosis 2.01 [0.19], P =0.001; relative wall thickness: NASH 0.49±0.05, isolated steatosis 0.47±0.06, without steatosis 0.46±0.06, P =0.011; cardiac index [L/m 2 ]: NASH 3.05±0.54, isolated steatosis 2.80±0.44, without steatosis 2.79±0.50, P =0.013. After adjustment for sex, age, blood pressure, and heart rate, most of the measures of the left ventricular systolic and diastolic function, left atrial size, right ventricular function, and right ventricular size did not differ between groups. Conclusions In a group of patients with extreme obesity, NASH was associated with left ventricular concentric remodeling and hyperdynamic circulation. Increased cardiac output in NASH may represent an additional risk factor for incident cardiovascular events in this population.

Association of Metabolic Dysfunction-Associated Fatty Liver Disease With Left Ventricular Diastolic Function and Cardiac Morphology

“…Published studies suggest that obesity adversely affects the cardiac structure and LV function before the onset of organic heart disease ( 18 ). A recent study found that NASH patients with extreme obesity were associated with LV concentric remodeling and hyperdynamic circulation ( 29 ). Like them, we have measured the waist circumstance, and subcutaneous fat, and these indicators were significantly higher in the overweight/obesity subgroup; the patterns of fat distribution may be related to the metabolic abnormalities and ectopic deposition of fat in the myocardium.…”

Liver Fibrosis as an Independent Cardiovascular Risk Factor in Non-alcoholic Fatty Liver Disease

“…19 In particular, left ventricular concentric remodeling, which was an unfavorable prognostic sign, was revealed in NASH patients. 20 LF in NASH may also be associated with CVDs by a more expressed profile of systemic inflammation affecting various organs and systems and the interactions between them, leading to further inflammation and immune response activation. 21…”

An Exploration of the Relationship Between Atrial Fibrillation and Obesity

“…66 Patients with extreme obesity and nonalcoholic steatohepatitis demonstrated left ventricular concentric remodeling and hyperdynamic circulation. 67 Furthermore, CRP levels are related to insulin resistance and the presence of metabolic syndromes, especially in women. 68 41 Obesity is associated with higher levels of CRP, with a stronger association in women and North Americans/Europeans, with gender differences only emerging in adulthood.…”

“…66 Patients with extreme obesity and nonalcoholic steatohepatitis demonstrated left ventricular concentric remodeling and hyperdynamic circulation. 67 Furthermore, CRP levels are related to insulin resistance and the presence of metabolic syndromes, especially in women. 68…”