Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis.

Jie Ning Yong, Cheng Han Ng, Chloe Wen-Min Lee, Yu Yi Chan, Ansel Shao Pin Tang, Margaret Teng, Darren Jun Hao Tan, Wen Hui Lim, Jingxuan Quek, Jieling Xiao, Yip Han Chin, Roger Foo, Mark Chan, Weiqin Lin, Mazen Noureddin, Mohammad Shadab Siddiqui, Mark D Muthiah, Arun Sanyal, Nicholas W S Chew

Journal: Hepatology international 2022;16(2):269-281

PMID: 35320497

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Abstract

OBJECTIVE

Several studies have documented a relationship between non-alcoholic fatty liver disease (NAFLD) and structural heart disease, particularly diastolic function. This meta-analysis will be the first to examine the echocardiographic-derived cardiac function and structural characteristics in NAFLD patients, and its association with liver disease severity and metabolic profile.

METHODS

Medline and Embase were searched and pairwise meta-analysis was conducted in DerSimonian and Laird to obtain the odds ratio (OR) and mean difference (MD) for dichotomous and continuous variables, respectively, to compare the effects of NAFLD on the echocardiography parameters.

RESULTS

Forty-one articles involving 33,891 patients underwent echocardiography. NAFLD patients had worse systolic indices with lower ejection fraction (EF, MD: - 0.693; 95% CI: - 1.112 to - 0.274; p = 0.001), and worse diastolic indices with higher E/e' (MD: 1.575; 95% CI: 0.924 to 2.227; p < 0.001) compared to non-NAFLD patients. NAFLD patients displayed increased left ventricular mass (LVM, MD: 34.484; 95% CI: 26.236 to 42.732; p < 0.001) and epicardial adipose thickness (EAT, MD: 0.1343; 95% CI: 0.055 to 0.214; p = 0.001). An increased severity of NAFLD was associated with worse diastolic indices (decreased E/A ratio, p = 0.007), but not with systolic indices.

CONCLUSIONS

NAFLD is associated with impaired systolic and diastolic function with changes in cardiac structure. Concomitant metabolic risk factors and liver disease severity are independently associated with worsening systolic and diastolic function.

Address: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.; Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA.; Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore. [email protected].; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore. [email protected].; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].; Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore. [email protected].

DOI: 10.1007/s12072-022-10319-6

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https://dx.doi.org/10.1007/s12072-022-10319-6

MeSH Terms: Diastole, Echocardiography, Humans, Non-alcoholic Fatty Liver Disease, Risk Factors, Ventricular Dysfunction, Left