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Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis

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Abstract

Objective

Several studies have documented a relationship between non-alcoholic fatty liver disease (NAFLD) and structural heart disease, particularly diastolic function. This meta-analysis will be the first to examine the echocardiographic-derived cardiac function and structural characteristics in NAFLD patients, and its association with liver disease severity and metabolic profile.

Methods

Medline and Embase were searched and pairwise meta-analysis was conducted in DerSimonian and Laird to obtain the odds ratio (OR) and mean difference (MD) for dichotomous and continuous variables, respectively, to compare the effects of NAFLD on the echocardiography parameters.

Results

Forty-one articles involving 33,891 patients underwent echocardiography. NAFLD patients had worse systolic indices with lower ejection fraction (EF, MD: − 0.693; 95% CI: − 1.112 to − 0.274; p = 0.001), and worse diastolic indices with higher E/e’ (MD: 1.575; 95% CI: 0.924 to 2.227; p < 0.001) compared to non-NAFLD patients. NAFLD patients displayed increased left ventricular mass (LVM, MD: 34.484; 95% CI: 26.236 to 42.732; p < 0.001) and epicardial adipose thickness (EAT, MD: 0.1343; 95% CI: 0.055 to 0.214; p = 0.001). An increased severity of NAFLD was associated with worse diastolic indices (decreased E/A ratio, p = 0.007), but not with systolic indices.

Conclusions

NAFLD is associated with impaired systolic and diastolic function with changes in cardiac structure. Concomitant metabolic risk factors and liver disease severity are independently associated with worsening systolic and diastolic function.

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Data availability

All articles in this manuscript are available from Medline and Embase.

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Author notes

  1. Jie Ning Yong and Cheng Han Ng have contributed equally to this work and share first authorship.

  2. Arun Sanyal and Nicholas W. S. Chew have equally supervised this work.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jie Ning Yong, Cheng Han Ng, Chloe Wen-Min Lee, Yu Yi Chan, Ansel Shao Pin Tang, Margaret Teng, Darren Jun Hao Tan, Wen Hui Lim, Jingxuan Quek, Jieling Xiao, Yip Han Chin, Roger Foo, Mark Chan, Weiqin Lin, Mark D. Muthiah & Nicholas W. S. Chew

  2. Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Margaret Teng & Mark D. Muthiah

  3. National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore

    Margaret Teng & Mark D. Muthiah

  4. Department of Cardiology, National University Heart Centre, National University Hospital, Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Roger Foo, Mark Chan, Weiqin Lin & Nicholas W. S. Chew

  5. Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Cedars-Sinai Medical Center, Comprehensive Transplant Center, Los Angeles, CA, USA

    Mazen Noureddin

  6. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Mohammad Shadab Siddiqui & Arun Sanyal

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  1. Jie Ning Yong
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Contributions

NWSC, MDM, AJS, MSS, MN, and CHN: conceptualization. JNY, CHN, CW-ML, YYC, ASPT, DJHT, WHL, JQ, X-HP, and YHC: data curation. JNY, CHN, CW-ML, YYC, and ASPT: formal analysis. NWSC, MDM, AJS, MSS, MN, WL, MC, and RF: supervision. DJHT, WHL, JQ, X-HP, and YHC: validation. JNY, CHN, CW-ML, YYC, ASPT, NC, and MT: writing—original draft. JNY, CHN, CW-ML, YYC, ASPT, MT, DJHT, WHL, JQ, X-HP, YHC, RF, MC, WL, MN, MSS, AJS, MDM, and NC: writing, review, and editing. All authors have read and approved the final version of the manuscript for submission.

Corresponding authors

Correspondence to Mark D. Muthiah or Nicholas W. S. Chew.

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Conflict of interest

Arun J. Sanyal: Dr Sanyal is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect and Galmed. He has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz and Genfit. He has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen and Bristol Myers Squibb. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland and Norvatis. He receives royalties from Elsevier and UptoDate. Mazen Noureddin: has been on the advisory board for 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens and Roche diagnostic; MN has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking and Zydus; MN is a minor shareholder or has stocks in Anaetos, Rivus Pharma and Viking. All other authors have no conflicts of interests.

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Yong, J.N., Ng, C.H., Lee, C.WM. et al. Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis. Hepatol Int 16, 269–281 (2022). https://doi.org/10.1007/s12072-022-10319-6

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  • DOI: https://doi.org/10.1007/s12072-022-10319-6

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