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NAFLD may be linked to heart failure
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In a cross-sectional analysis, researchers found that nonalcoholic fatty liver disease was independently associated with subclinical myocardial remodeling and dysfunction, which may indicate an association with heart failure.
“There are several well-established major risk factors for the development of clinical heart failure, including coronary artery disease, diabetes and hypertension, all of which are also closely associated with NAFLD,” Lisa B. VanWagner, MD, MSc, of Northwestern University Feinberg School of Medicine, told Healio.com/Hepatology. “We demonstrate, taking into account a comprehensive set of well-measured metabolic covariates, that NAFLD is in fact associated with subclinical myocardial remodeling and dysfunction independent of metabolic risk factors.”
Lisa B. VanWagner
To determine this association, VanWagner and colleagues analyzed data of 2,713 patients from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a community-based, longitudinal study of the development and determinants of cardiovascular disease in black and white adults. All patients underwent computed tomography quantification of liver fat and comprehensive echocardiography with myocardial strain measured by speckle tracking. The subclinical left ventricular (LV) systolic dysfunction was defined using values of absolute peak global longitudinal strain (GLS), according to the research. Of the patients included, 58.8% were women, 48% black and the prevalence of NAFLD was 10% (n = 271).
Results indicated that patients with NAFLD had lower early diastolic relaxation (e’) velocity compared with the patients without NAFLD (10.8 ± 2.6 vs. 11.9 ± 2.8 cm/s), as well as higher LV filling pressure (E/e’ ratio: 7.7 ± 2.6 vs. 7 ± 2.3) and worse absolute GLS (14.2 ± 2.4% vs. 15.2 ± 2.4%) compared with patients without NAFLD (P < .0001 for all). Cardiac output was also higher in NAFLD patients. However, this was “attenuated after accounting for body surface area,” according to the research.
After adjusting for heart failure (HF) risk factors or BMI, analysis showed that NAFLD was still associated with subclinical myocardial remodeling and dysfunction (P < .01).
“These results imply that identification of NAFLD may help to identify those at increased risk for future development of clinical heart failure, and provide pathophysiologic insight into the development of HF, particularly [heart failure and preserved ejection fraction] by showing, for the first time, that liver fat is associated with abnormalities in myocardial mechanics,” VanWagner said. – by Melinda Stevens
Disclosures: VanWagner reports no relevant financial disclosures. Please see the study for a full list of other authors’ relevant financial disclosures.
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Rohit Loomba, MD, MHSc
This important study published in Hepatology provides new insights into the association between liver fat content assessed by computed tomography and myocardial dysfunction on 2D echocardiogram.
CT picks up fatty liver at a higher liver fat content and, therefore, patients classified as NAFLD by CT are likely to have a higher degree of fat content than if MRI is used to diagnose NAFLD. The reason for this observation is that CT, although convenient, is less sensitive and less accurate than MRI. MRI can quantify fat at a cut-point of 5% and diagnose NAFLD with very high accuracy. However, CT may not be accurate when the liver fat content is between 5% to 15%.
The prevalence of NAFLD at 10% ( much lower than expected) supports this notion. Utilizing the CARDIA cohort to study this association is an innovative and cost-effective way to examine these important clinical associations. A recent study by Arulanandan et al in Clinical Gastroenterology and Hepatology (in press) showed that higher degree of liver fat content was associated with cardiovascular risk even after adjusting for NASH on liver biopsy. Putting these results into perspective, this study by VanWagner and colleagues provides novel data that higher liver fat content is associated with risk factors of heart failure. I congratulate the study team for their fine accomplishment.
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