Correlation between Nonalcoholic Fatty Liver Disease and Early Left Ventricular Diastolic Dysfunction

Abstract

Background As the most common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with significant changes in myocardial structure and function, but it is still a controversial issue whether it is an independent risk factor for abnormalities in cardiac structure and function. Objective To assess the correlation of NAFLD with early left ventricular diastolic dysfunction by comparing left ventricular structure and functional indices between NAFLD and non-NAFLD patients. Methods A total of 519 inpatients from Geriatric Medicine Unit, Peking University People's Hospital were enrolled during 2018 to 2020, and divided into NAFLD group and non-NAFLD group according to the results of abdominal ultrasound or CT examination. Left ventricular structural and functional indices of two groups were comparatively analyzed. Early left ventricular diastolic dysfunction was defined as the ratio of the peak velocity of the early filling (E) wave to the atrial contraction (A) wave <1. Multivariate Logistic regression was used to assess the correlation between NAFLD and early left ventricular diastolic dysfunction. FIB-4 index was used to assess the risk of liver fibrosis in NAFLD patient〔low risk (<1.30) , medium risk (1.30-3.25) , and high risk (>3.25) 〕. NAFLD patients were divided into low-risk subgroup (n=81) and medium-high risk subgroup (n=100) according to whether FIB-4 index <1.30. Results Compared with the non-NAFLD patients (n=338) , NAFLD patients had lower E/A ratio〔 (0.79±0.25) vs (0.87±0.34) , t=2.607, P=0.009) 〕 and greater end-diastolic interventricular septal thickness〔 (0.92±0.13) cm vs (0.89±0.13) cm, t=-2.525, P=0.012〕. Multivariate Logistic regression analysis showed that NAFLD was independently associated with the risk of early left ventricular diastolic dysfunction〔OR=2.941, 95%CI (1.736, 4.981) , P<0.001〕. NAFLD patients with medium-high risk subgroup had lower E/A ratio〔 (0.75±0.21) vs (0.84±0.28) , t=2.275, P=0.024〕 and higher left ventricular mass index than did those with low-risk subgroup〔 (80.22±14.92) g/m2 vs (74.72±16.83) g/m2, t=-2.327, P=0.021〕. Conclusion NAFLD may be an independent risk factor for early left ventricular diastolic dysfunction. The higher risk of advanced fibrosis in NAFLD patients, the worse was the left ventricular diastolic function.

Keywords

• non-alcoholic fatty liver disease|hepatic fibrosis|left ventricle|ventricular dysfunction|root cause analysis