Fatty liver disease, heart rate and cardiac remodelling: Evidence from the UK Biobank

Abstract

Background and Aims: Growing evidence supports an association between fatty liver disease (FLD) and cardiac dysfunction and remodelling, leading to cardiovascular disease and heart failure. Herein, we investigated the independent contribution of FLD to cardiac dysfunction and remodelling in participants from the UK Biobank with cardiac magnetic resonance (CMR) data available.Methods: A total of 18 848 Europeans without chronic viral hepatitis and valvular heart diseases, with liver magnetic resonance imaging and CMR data were included in the analyses. Clinical, laboratory and imaging data were collected using standardized procedures. Multivariable regression models were used to test the association between FLD and CMR endpoints, after adjusting for several cardiometabolic risk factors. Linear regression models with regularization (Least Absolute Shrinkage and Selection Operator [LASSO], Ridge and Elastic Net) were used to generate predictive models for heart-related endpoints.Results: FLD was independently associated with higher average heart rate, higher cardiac remodelling (higher eccentricity ratio and lower remodelling index), lower left and right ventricular volumes (end-systolic, end-diastolic and stroke volumes) as well as with lower left and right atrial maximal volumes (p < 0.001). FLD was the strongest positive predictor for average heart rate, followed by age, hypertension and type 2 diabetes. Male sex was the strongest positive predictor for eccentricity ratio followed by FLD, age, hypertension and BMI. For LV volumes, FLD was the strongest negative predictor along with age.Conclusions: FLD is an independent predictor of higher heart rate and early cardiac remodelling associated with reduced ventricular volumes.

Non‐alcoholic fatty liver disease mediates the effect of obesity on arterial hypertension

“…34,35 A recent large and elegantly conducted study using data from the UKBB showed that NAFLD is an independent predictor of higher HR and early cardiac remodelling associated with reduced ventricular volumes. 36 Second, our study suggests that the role of liver fibrosis on the effect by which obesity might potentially influence arterial hypertension is still inconclusive. For example, by constructing a mediation analysis, we did not observe any effect of liver fibrosis (non-invasively estimated by NFS) on the relationship between BMI and blood pressure in the young population of the BHS.…”

“…Elevated pulse pressure has been shown to provide independent prognostic information on CV mortality and multiple adverse CV outcomes in population‐based studies 34,35 . A recent large and elegantly conducted study using data from the UKBB showed that NAFLD is an independent predictor of higher HR and early cardiac remodelling associated with reduced ventricular volumes 36 …”

Reply to: “Fatty liver disease at the basis of cardiac remodelling and increased heart rate: Insights from the UK Biobank”

“…All participants gave written informed consent to the study. Federica Tavaglione 1,2 Oveis Jamialahmadi 1 Charlotta Ljungman 1,3 Stefano Romeo 1,3,4 1 Department of Molecular and Clinical Medicine, Sahlgrenska…”

“…We thank Boeckmans and Schattenberg for their positive comments on our published work 1 where we demonstrated that fatty liver disease (FLD) is associated with (a) higher heart rate (beta coefficient 0.364, p < .001) and cardiac remodelling (beta coefficient 0.433 and −0.406, for eccentricity ratio and remodelling index, respectively, p < .001) and (b) with reduced ventricular volumes independently of traditional metabolic and cardiovascular risk factors. Notably, the analysis included more than 18 000 Europeans from the UK Biobank study with liver magnetic resonance imaging proton density fat fraction (MRI‐PDFF) and cardiac magnetic resonance (CMR) data available.…”

“…Reply to: "Fatty liver disease at the basis of cardiac remodelling and increased heart rate: Insights from the UK Biobank" Dear Editor, We thank Boeckmans and Schattenberg for their positive comments on our published work 1 where we demonstrated that fatty liver disease (FLD) is associated with (a) higher heart rate (beta coefficient 0.364, p < .001) and cardiac remodelling (beta coefficient 0.433 and −0.406, for eccentricity ratio and remodelling index, respectively, p < .001) and (b) with reduced ventricular volumes independently of traditional metabolic and cardiovascular risk factors.…”