Presence of atrial fibrillation is associated with liver stiffness in an elderly Finnish population

Abstract

BackgroundChronic liver injury from different etiologies drives liver fibrosis. However, little is known about the associated factors, systemic factors in particular. Recently, non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation have been shown to be associated with each other. Thereby, we aimed to study the association between atrial fibrillation and liver stiffness.StudyExtensive clinical measurements including echocardiography of the heart, transient elastography (TE) of the liver and the presence of atrial fibrillation were determined in elderly Finnish study subjects (n = 76, mean age 73 years) from OPERA (Oulu Project Elucidating the Risk of Atherosclerosis) study cohort. Half of the study subjects had non-alcoholic fatty liver disease, whereas others did not have any known hepatic morbidity. The present study was cross-sectional by nature.ResultsThe subjects with atrial fibrillation had higher TE values (with atrial fibrillation TE = 9.3kPa, without atrial fibrillation TE = 6.3kPa, p = 0.018). When the cohort was divided to four subgroups (those without NAFLD or atrial fibrillation, with NAFLD but without atrial fibrillation, with both conditions, and with atrial fibrillation but without NAFLD), the TE value was the highest in the subjects with both conditions (5.3kPa, 7.4kPa, 10.8kPa and 7.8kPa, respectively, p = 0.019). Moreover, the higher the TE value, the more prevalent atrial fibrillation was (the atrial fibrillation prevalence by tertiles of TE 27% / 36% / 77%, p = 0.001). Likewise, the greater the TE value, the greater the left atrial diameter, a collateral of atrial fibrillation (left atrial diameters by tertiles of TE 39mm / 45mm / 48mm, p<0.001) was. All these p-values for continuous variables remained statistically significant even after adjustment for common clinically relevant risk factors.ConclusionsThere is an association between atrial fibrillation and liver stiffness. This novel association may have multiple explanations and mechanistic links, which are discussed here and need further studies, prospective studies in particular.

Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

“…After excluding duplicates, based on the titles and abstracts of 89 citations (in accordance with the aforementioned exclusion criteria of the meta‐analysis), we initially identified 11 potentially relevant studies from PubMed, Web of Science and Scopus databases prior to December 14, 2018 (date last searched). After examining the full text of these 11 publications, we further excluded 2 studies, because of unsatisfactory inclusion criteria ( n = 1) or unsatisfactory outcome measures ( n = 1), as specified in the PRISMA flow diagram.…”

“…We used STATA® 14.2 (StataCorp, College Station, Texas) for all statistical analyses. the full text of these 11 publications, [11][12][13][14][15][16][17][18]24,25 we further excluded 2 studies, 24,25 because of unsatisfactory inclusion criteria (n = 1) or unsatisfactory outcome measures (n = 1), as specified in the PRISMA flow diagram.…”

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

“…One article was excluded due to the presence of alcoholic hepatic steatosis and another one was excluded as the full article was not found. We finally analysed 20 papers [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…The diagnosis of NAFLD using abdominal ultrasonography is usually performed by assessing the echogenicity of the liver in comparison to that of the right kidney and the diaphragm (31). In our review, most studies used ultrasonography for diagnosing NAFLD (n=13) [11,13,[18][19][20][21][22][23][24][25][26][27]29], while others used both ultrasonography and elastography (n=2) [10,16], CT (n=2) [15,28], either CT or ultrasonography (n=1) [14], either ICD-9 code or biopsy (n=1) [12] and 1 used FLI [17]. Cardiac Arrhythmias A total of 12 studies assessed the association of NAFLD and cardiac arrhythmias (Table I).…”

“…Atrial fibrillation was studied in 10 studies [10-12, 15-17, 19, 21, 25, 26], ventricular arrhythmias in 1 study [20] and 1 study did not mention which type of arrhythmia was present [28]. The diagnosis of cardiac arrhythmias was mainly based on standard ECG (n=8) [10,11,15,17,19,21,25,26], 24-hour Holter ECG (n= 1) [20], ICD-9 (n=2) [12,28] and ICD-10 code (n=1) [16].…”