Non-Alcoholic Fatty Liver Disease and Echocardiographic Parameters of Left Ventricular Diastolic Function: A Systematic Review and Meta-Analysis

Abstract

The cardiovascular implications of non-alcoholic fatty liver disease (NAFLD) have been associated with heart failure with preserved ejection fraction (HFpEF). The purpose of this review was to conduct a bibliographic search regarding the correlation between NAFLD and the echocardiographic parameters of left ventricular diastolic function. A systematic literature search was conducted in PubMed and Embase for original research data reporting on the association of NAFLD with diastolic function markers [E/e′, left atrial volume index (LAVi), left ventricular mass index (LVMi)]. Meta-analysis was performed using the meta and dmetar packages in R studio v.1.4.1106, with p < 0.05 values being considered significant. Results are expressed as the standardized mean difference (SMD) for continuous variables and as the odds ratio (OR) for categorical variables, with respective 95% confidence intervals (CI). Heterogeneity between studies was expressed with index Ι2. From the preliminary search, 2619 articles were found from which 31 studies were included in the final statistical analysis. The meta-analysis of 8 studies which reported on the prevalence of diastolic dysfunction showed that it was increased in patients with NAFLD (OR: 2.07, 95% CI 1.24–3.44 with p = 0.01, I2: 80% with p < 0.01). The meta-analysis of 21 studies showed significantly higher E/e′ in NAFLD patients (SMD 1.02, 95% CI 0.43–1.61 with p < 0.001, I2: 97% with p < 0.001). Individuals with NAFLD had increased LAVi (SMD: 0.87, 95% CI 0.38–1.37 with p < 0.001, I2: 96% with p < 0.001) and LVMi (SMD: 0.89, 95% CI 0.31–1.48 with p = 0.003, I2: 100% with p < 0.001). To conclude, in the meta-analysis of 31 observational studies, NAFLD patients were found to have affected left ventricular diastolic function, supporting the hypothesis of NAFLD being associated with HFpEF.

Impairment in Right Ventricular-Pulmonary Arterial Coupling in Overweight and Obesity

“…Obesity significantly influences the likelihood that a symptomatic patient suffers from HFpEF [ 4 ] and is correlated with atrial fibrillation development, a common and serious cardiac arrhythmia [ 5 ]. Moreover, metabolic-associated fatty liver disease (MAFLD), which frequently accompanies obesity, is implicated in the incidence of left ventricular (LV) diastolic function impairment, further complicating the cardiovascular health of obese individuals [ 6 ]. The detrimental impact of obesity extends to worse invasive hemodynamic measurements of right ventricular function in patients undergoing right heart catheterization, highlighting the pervasive effects of excess body weight on cardiac performance [ 7 ].…”

Lipid droplets in steatotic liver disease

“…presence of lipid droplets in ≥5% of hepatocytes) through to nonalcoholic steatohepatitis (NASH) and eventually liver cirrhosis [2]. Not only does SLD increase the risk of liver-related mortality, but it is also a contributing factor to various extra-hepatic diseases including cardiovascular disease [3,4], chronic kidney disease [5,6] and several cancers [7]. The mechanisms underlying the pathogenesis and progression of SLD are unclear and likely include a complex combination and interplay of environmental and genetic risk factors [8].…”