Left ventricular strain predicts subclinical atherosclerosis in nonadvanced nonalcoholic fatty liver disease patients

Abstract

Objectives The association between nonalcoholic fatty liver disease (NAFLD) and carotid atherosclerosis is still controversial. The present study was designed to assess the relationship between left ventricular systolic mechanics, noninvasively assessed by two-dimensional (2D) speckle-tracking echocardiography (STE) and common carotid artery (CCA) intima-media thickness (IMT), in patients with nonadvanced NAFLD. Methods All consecutive NAFLD patients diagnosed with liver stiffness measurement (LSM) <12.5 kPa on transient elastography between September 2021 and December 2021 were prospectively enrolled. All participants underwent blood tests, transient elastography, 2D transthoracic echocardiography (TTE) implemented with 2D-STE analysis of left ventricular (LV) global longitudinal strain (GLS) and finally carotid ultrasonography. Main independent predictors of subclinical atherosclerosis, defined as CCA-IMT >0. 9 mm, were evaluated. Results A total of 92 NAFLD patients (54.0 ± 11.1 years, 50% males) were prospectively analyzed. Mean LSM was 6.2 ± 2.4 kPa. FibroScan results revealed that 76.1% of patients had F0-F1, 5.4% F2 and 18.5% F3 liver fibrosis. Despite normal biventricular systolic function on 2D-TTE, LV-GLS was reduced (less negative than −20%) in 64.1% of patients. However, 62.0% of NAFLD patients were found with CCA-IMT >0. 9 mm. Age [odds ratio (OR),1.19; 95% confidence interval (CI), 1.05-1.36], hypertension (OR, 3.73; 95% CI, 1.53-9.11), LSM (OR, 4.83; 95% CI, 2.43-9.59), LV-GLS (OR, 0.49; 95% CI, 0.36-0.68) and statin therapy (OR, 0.10; 95% CI, 0.02-0.60) were independently associated with subclinical atherosclerosis. Age ≥51 years, LSM ≥5.5 kPa and LV-GLS less negative than −20% were the best cutoff values for predicting subclinical atherosclerosis. Conclusions Subclinical myocardial dysfunction and subclinical atherosclerosis are simultaneously present in patients with nonadvanced NAFLD.

Systematic review and meta‐analysis: Association between liver fibrosis and subclinical atherosclerosis in nonalcoholic fatty liver disease

“…Three studies utilised CAC scores to assess atherosclerosis, 22,23,28 while two studies used PWV 20,29 . One study employed an AI for this purpose, 21 while the other six studies used IMT measurements 19,24–27,30 …”

“…Specifically, three studies utilised liver biopsy to determine fibrosis stage, 19–21 while two used MRE 22,23 . The remaining seven studies used TE to assess the fibrosis stage 24–30 …”

“…Among the selected studies, a total of nine studies reported adjusted ORs, which were obtained after controlling for relevant confounding factors through appropriate statistical adjustments 19–23,25,28–30 . Additionally, three studies provided unadjusted ORs, indicating the association between the variables without accounting for potential confounders 24,26,27 …”

“…22,23 The remaining seven studies used TE to assess the fibrosis stage. [24][25][26][27][28][29][30] Different methods were employed across the included studies to measure atherosclerosis. Three studies utilised CAC scores to assess atherosclerosis, 22,23,28 while two studies used PWV.…”

“…20,29 One study employed an AI for this purpose, 21 while the other six studies used IMT measurements. 19,[24][25][26][27]30…”