Nonalcoholic Fatty Liver Disease Is Related to Abnormal Corrected QT Interval and Left Ventricular Hypertrophy in Chinese Male Steelworkers

Abstract

Objectives: Nonalcoholic fatty liver disease (NAFLD) has been associated with an increased risks of corrected QT (QTc) prolongation and left ventricular hypertrophy (LVH), both of which are associated with the development of cardiovascular disease. Rotating night shift work and a higher risk of incident NAFLD have been reported in male steelworkers. This study aimed to investigate the association of the severity of NAFLD with a prolonged QTc interval and LVH in a large cohort of Chinese male steelworkers. Methods: We examined baseline data of 2998 male steel workers aged 26 to 71 years at two plants. All workers at both plants received regular health assessments, including 12-lead ECG and echocardiography. Abdominal ultrasonography was performed to evaluate the severity of NAFLD. QTc prolongation was defined as follows: normal ≤ 430 ms, borderline 431–450 ms, and abnormal ≥ 451 ms. LVH was defined as a left ventricular mass index (LVMI) >131 g/m2. Associations of NAFLD with an abnormal QTc interval and LVH were examined using univariate and multivariate analyses. Results: The QTc interval and the LVMI were significantly correlated with the NAFLD fibrosis score, and the severity of NAFLD was correlated with an abnormal QTc interval and LVH (p for trend < 0.05). Multivariate analysis showed that in comparison to the workers without NAFLD, the odds ratios of having an abnormal QTc interval and LVH were 2.54 (95% CI: 1.22–5.39, p = 0.013) times and 2.23 (95% CI: 1.02–5.01, p = 0.044) times higher in the workers with moderate/severe NAFLD. Conclusions: NAFLD may be closely associated with the risks of an abnormal QTc interval and LVH, suggesting that regular electrocardiogram and echocardiogram monitoring could be used to evaluate the risk of arrhythmia and LVH in male steelworkers with NAFLD.

The association between nonalcoholic fatty liver disease and corrected QT interval prolongation among generally healthy Iranian population: Fasa Cohort Study (FACS)

“…Our findings are consistent with the previous studies investigating the association between NAFLD and QTc prolongation 23–26 . According to a study by Targhar et al 23 conducted on 400 Italian participants, the presence and severity of NAFLD had an association with increased QTc interval in type 2 DM patients with an adjusted OR of 2.26 (95% CI: 1.4–3.7).…”

“…Our findings are consistent with the previous studies investigating the association between NAFLD and QTc prolongation. [23][24][25][26] According to a study by Targhar et al 23 | 619 caused by a low-grade inflammatory response mediated by different cytokines, which can affect the myocardium and cause an increase in action potential duration and QTc interval. 27 TNF-α has been implicated as a proinflammatory cytokine in the induction of calcium leakage from the sarcoplasmic reticulum, which leads to QTc prolongation and arrhythmia.…”

“…Our findings are consistent with the previous studies investigating the association between NAFLD and QTc prolongation. 23 , 24 , 25 , 26 According to a study by Targhar et al 23 conducted on 400 Italian participants, the presence and severity of NAFLD had an association with increased QTc interval in type 2 DM patients with an adjusted OR of 2.26 (95% CI: 1.4–3.7). In another study consisting of 31 116 Taiwanese cases, 25 NAFLD severity had a positive correlation with prolonged QTc interval in both genders [adjusted OR in men 1.87 (1.51–2.31) and in women 1.31 (1.16–2.24)].…”

“…In another study consisting of 31 116Taiwanese cases,25 NAFLD severity had a positive correlation with an OR of 2.05 (1.13-3.71) 26. Furthermore, in a study of 2998 Chinese male steelworkers, Hung et al24 reported a positive association of NAFLD severity with QTc prolongation [adjusted OR: 2.54 (1.22-5.39)].Although previous studies in Western or far East Asian countries with mostly fewer subjects found a significantly positive association generally healthy Iranians. There are several possible explanations for the association between NAFLD and QTc prolongation.…”

“…There are several possible explanations for the association between NAFLD and QTc prolongation. Diabetes, smoking, systolic and diastolic blood pressure, hemoglobin A1c, high-density lipoprotein concentration, BMI, and WBC count are associated with developing QTc prolongation in individuals with NAFLD 10,24,25. Inflammatory processes could be another underlying mechanism.…”