Association between non-alcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population

Kazutoshi Hirose; Koki Nakanishi; Marco R Di Tullio; Shunichi Homma; Naoko Sawada; Yuriko Yoshida; Megumi Hirokawa; Katsuhiro Koyama; Koichi Kimura; Tomoko Nakao; Masao Daimon; Hiroyuki Morita; Makoto Kurano; Issei Komuro

doi:10.1093/ehjopen/oead108

Association between non-alcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population

Eur Heart J Open. 2023 Oct 17;3(6):oead108. doi: 10.1093/ehjopen/oead108. eCollection 2023 Nov.

Authors

Kazutoshi Hirose¹, Koki Nakanishi^{1

2}, Marco R Di Tullio³, Shunichi Homma³, Naoko Sawada¹, Yuriko Yoshida³, Megumi Hirokawa^{1

2}, Katsuhiro Koyama¹, Koichi Kimura¹, Tomoko Nakao¹, Masao Daimon^{1

4}, Hiroyuki Morita¹, Makoto Kurano², Issei Komuro^{1

4

5}

Affiliations

¹ Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
² Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
³ Department of Medicine, Columbia University, NewYork, NY, USA.
⁴ International University of Health and Welfare, Tokyo, Japan.
⁵ Department of Frontier Cardiovascular Science, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.

Abstract

Aims: Emerging evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and heart failure (HF). We investigated the relationship between NAFLD and left ventricular (LV) functional remodelling in a general population sample without overt cardiac and liver disease.

Methods and results: We included 481 individuals without significant alcohol consumption who voluntarily underwent an extensive cardiovascular health check. The fatty liver index (FLI) was calculated for each participant, and NAFLD was defined as FLI ≥ 60. All participants underwent 2D transthoracic echocardiography; LV global longitudinal strain (LVGLS) was assessed with speckle-tracking analysis. Univariable and multivariable linear regression models were constructed to investigate the possible association between NAFLD and LVGLS. Seventy-one (14.8%) participants were diagnosed with NAFLD. Individuals with NAFLD exhibited larger LV size and LV mass index than those without NAFLD, although left atrial size and E/e' ratio did not differ between groups. Left ventricular global longitudinal strain was significantly reduced in participants with vs. without NAFLD (17.1% ± 2.4% vs. 19.5% ± 3.1%, respectively; P < 0.001). The NAFLD group had a significantly higher frequency of abnormal LVGLS (<16%) than the non-NAFLD group (31.0% vs. 10.7%, respectively; P < 0.001). Multivariable linear regression analysis demonstrated that higher FLI score was significantly associated with impaired LVGLS independent of age, sex, conventional cardiovascular risk factors, and echocardiographic parameters (standardized β -0.11, P = 0.031).

Conclusion: In the general population without overt cardiac and liver disease, the presence of NAFLD was significantly associated with subclinical LV dysfunction, which may partly explain the elevated risk of HF in individuals with NAFLD.

Keywords: Fatty liver index; Left ventricular global longitudinal strain; Non-alcoholic fatty liver disease; Speckle-tracking echocardiography.