Doppler Tissue Evaluation of Atrial Conduction Properties in Patients With Non-alcoholic Fatty-liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in clinical practice, and there is an increasing trend in its prevalence in the general population. Recent studies have demonstrated increased risk of atrial fibrillation (AF) in NAFLD. However, information on the mechanism of increased risk of AF in NAFLD is lacking. Impaired atrial conduction is an important factor in the pathophysiology of AF. We aimed to investigate atrial conduction properties in patients with NAFLD by tissue Doppler echocardiography. Fifty-nine ultrasound diagnosed NAFLD patients without clinical diagnosis of hypertension, diabetes mellitus, or cardiac disease and 22 normal subjects as controls were included in this study. Atrial conduction properties were assessed by electromechanical delay (EMD) derived from Doppler tissue echocardiography examination and P-wave dispersion (PWD) calculated from the 12-lead electrocardiogram. Inter-atrial and intra-atrial EMD intervals were significantly longer in NAFLD patients than in controls (inter-atrial EMD, 31.9 ± 8.5 ms vs. 23.4 ± 4.6 ms,p= 0.0001, and intra-atrial EMD, 14.3 ± 5.2 vs. 10.2 ± 4.0 ms,p= 0.001). Similarly, PWD was significantly higher in NAFLD patients compared with controls (49.2 ± 6.3 ms vs. 43.3 ± 4.2 ms,p= 0.0001). Maximum left atrial volume was also significantly higher in the NAFLD group than in controls (51 ± 11 mL vs. 34 ± 9 mL,p< 0.0001). This study demonstrated that atrial conduction is impaired in patients with NAFLD. Also, in a patient population of NAFLD without any clinical diagnosis of cardiac disease, diabetes, or hypertension, left atrial volume was increased compared with controls. These findings suggest impaired atrial conduction as a factor in increased risk of AF in NAFLD.

P-wave dispersion: an update

“…Non-alcoholic fatty liver disease (NAFLD) without cardiac disease, diabetes, or hypertension: in a population of NAFLD without any clinical diagnosis of cardiac disease, diabetes, hypertension, increased left atrial volume, PWD was significantly higher when compared with controls [30].…”

Pathogenesis of Insulin Resistance and Atherogenic Dyslipidemia in Nonalcoholic Fatty Liver Disease

“…This increased epicardial adipose tissue is associated with sympathovagal imbalances that can predispose to cardiac arrhythmias, such as first degree heart block prolongation and atrial fibrillation. [106][107][108][109][110][111] A prospective cohort study following diabetic patients for 10 years showed that patients with NAFLD developed atrial fibrillation more often than the controls. 112 These findings suggest a potential role for screening and surveillance of atherogenic dyslipidemia in patients with NAFLD.…”

Atrial fibrillation is highly prevalent yet undertreated in patients with biopsy‐proven nonalcoholic steatohepatitis

“…Additionally, patients with NAFLD have alterations in cardiac structure which may predispose to AF development . A number of studies have reported increased left atrial volume and size, left ventricular wall thickness and mass, and impaired diastolic function among persons with NAFLD, which are known risk factors for the development of AF . In a recent large population‐based study of over 3000 black and white middle‐aged adults with CT‐diagnosed NAFLD, NAFLD was independently associated with subclinical myocardial remodelling and dysfunction independent of established heart failure risk factors .…”

“…41 A number of studies have reported increased left atrial volume and size, left ventricular wall thickness and mass, and impaired diastolic function among persons with NAFLD, which are known risk factors for the development of AF. [41][42][43] In a recent large population- (GGT), a marker of both hepatocyte injury and systemic oxidative stress, is independently associated with incident AF, whereas aminotransferases, as markers of hepatocyte injury alone, have not been independently associated with incident AF. 44 Fibrosis itself may play a significant role in the development of…”