Korean J Gastroenterol.  2021 Sep;78(3):161-167. 10.4166/kjg.2021.040.

Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease

• Johnson PC
• Cochet AA
• Gore RS
• Harrison SA
• Magulick JP
• Aden JK
• Paredes AH

• KMID: 2520357
• DOI: http://doi.org/10.4166/kjg.2021.040

Abstract

Background/Aims
Nonalcoholic fatty liver disease (NAFLD) encompasses a range of diseases from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and has been linked to cardiovascular disease and sub-clinical cardiac remodeling. This paper presents a retrospective study of biopsy-proven NAFL and NASH to examine the differences in subclinical cardiac remodeling.
Methods
Patients were recruited from an institutional repository of patients with liver-biopsy-confirmed NAFLD. Patients with a transthoracic echocardiogram (TTE) within 12 months of the liver biopsy were included. The parameters of the diastolic dysfunction were reviewed for the differences between NAFL and NASH as well as between the stages and grades of NASH.
Results
Thirty-three patients were included in the study, 17 with NAFL and 16 with NASH. The NASH patients were more likely to have lower platelets, higher AST, higher ALT, and higher rates of type 2 diabetes mellitus, coronary artery disease, and hypertension than the NAFL patients. The E/e’ ratio on transthoracic echocardiogram was significantly higher in NASH compared to NAFL, advanced-stage NASH compared to early stage, and high-grade NASH compared to low-grade. The E/e’ ratio was also significantly higher in NASH than NAFL in patients without diabetes mellitus. The presence of diastolic dysfunction trended toward significance. The other markers of diastolic dysfunction were similar. Logistic regression revealed a statistical association with E/e' and NASH.
Conclusions
NASH patients had evidence of a higher E/e’ ratio than NAFL, and there was a trend towards a significant diastolic dysfunction. Patients with NASH compared to NAFL should be closely monitored for signs and symptoms of cardiac dysfunction.

Keyword

Non-alcoholic fatty liver disease; Steatohepatitis; Diastolic heart failure; Cardiac diseases

Figure

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  Fig. 1 E/e’ ratio for NAFL versus NASH, non-advanced versus advanced NASH, and low grade versus high-grade NASH. NAFL, nonalcoholic fatty liver; NASH, nonalcoholic steatohepatitis.

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