Nonalcoholic Steatohepatitis is Associated with Cardiac Remodeling and Dysfunction

Abstract

Objective Preliminary data suggest that nonalcoholic fatty liver disease (NAFLD) is associated with early heart failure (HF). However, whether nonalcoholic steatophepatitis (NASH) is directly associated with echocardiographic changes in cardiac structure or function remains unknown. Methods We identified a retrospective cohort (N=65) without known heart disease, undergoing elective bariatric surgery with perioperative liver biopsy, and available recent transthoracic echocardiography (TTE). TTE measures were evaluated by NASH status using correlation coefficients, ANOVA and linear regression, accounting for cardiometabolic factors. Results Median age was 47 years; 22% (n=14) had NASH. NASH patients had increased median left atrial (LA) volume (28.6mL/m2 vs. 24.8mL/m2, p<0.0001) and LV mass (82.6 g/m2 vs. 78.6 g/m2, p<0.0001), indexed for height. NASH was inversely correlated with indices of diastolic function, including septal E′ (r= −0.90 [95% CI −1.21, −0.42], p=0.020) and E:A (r= −0.31 [95% CI −0.51, −0.09], p=0.037). In adjusted analyses, NASH remained associated with increased LV mass index (ß1 = 7.16 [SE 4.95], p=0.001), LA volume index (ß1= 0.19 [0.08], p=0.001), and reduced lateral and septal E′ (ß1 = −0.91, p=0.015; ß1 = −0.89, p=0.047, respectively). Conclusions In this bariatric cohort, NASH was associated with changes in myocardial structure and in loaddependent indices of LV diastolic function, suggestive of subclinical HF.

Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic steatohepatitis

“…Petta et al [15] in a multivariate model found no significant differences in left ventricular mass or early annular diastolic tissue velocity in NAFLD patients. Our results are consistent with Simon et al [16], but given the conflicting evidence in the literature future studies are needed to further validate our results.…”

“…However, these studies provide conflicting reports on the relationship between NAFLD and LVDD. For example, Simon et al [16] showed that NAFLD was associated with significant Left ventricular diastolic dysfunction in liver transplantation echocardiographic abnormalities consistent with progressive LVDD; however, the study was limited by a small sample size and did not account for confounders of NASH and heart failure. Karabay et al [14] compared an NAFLD cohort to healthy controls.…”

Inhibiting Interleukin 11 Signaling Reduces Hepatocyte Death and Liver Fibrosis, Inflammation, and Steatosis in Mouse Models of Nonalcoholic Steatohepatitis

“…The primary causes of mortality in NASH are cardiovascular: myocardial infarction, renal failure, and stroke. 27,28 We measured biomarkers of cardiovascular risk in Il11ra1 -/mice after 16 weeks on WDF. As compared with littermate controls, Il11ra1 -/mice on WDF had lower levels of fasting blood glucose, serum cholesterol, and triglycerides ( Figure 2L-N).…”

Association of NAFLD Fibrosis Score with Subclinical Myocardial Remodeling in Patients with Type 2 Diabetes: A Cross-Sectional Study in China

“…In addition to liver-related complication, a growing body of evidence has indicated a close relationship between NAFLD and cardiovascular disease (CVD) [3][4][5]. Patients with NAFLD have a higher prevalence of CVD and are more likely to die from CVD than from liver-related death [4][5][6].…”

“…In addition to liver-related complication, a growing body of evidence has indicated a close relationship between NAFLD and cardiovascular disease (CVD) [3][4][5]. Patients with NAFLD have a higher prevalence of CVD and are more likely to die from CVD than from liver-related death [4][5][6]. Among the categories of NAFLD, liver brosis is considered as the main indicator of prognosis in NAFLD and was found to be independently associated with CVD and motality in different populations [6][7][8].…”