, Volume 66, Issue 3, pp 467–476 | Cite as

Association between nonalcoholic fatty liver disease and cardiac function and structure—a meta-analysis

  • Marta Borges-CanhaEmail author
  • João Sérgio Neves
  • Diogo Libânio
  • Madalena Von-Hafe
  • Catarina Vale
  • Miguel Araújo-Martins
  • Ana Rita Leite
  • Pedro Pimentel-Nunes
  • Davide Carvalho
  • Adelino Leite-Moreira



Nonalcoholic fatty liver disease is increasingly recognized as the hepatic counterpart of metabolic syndrome. It is hypothesized that structural and functional cardiac changes may be associated with this metabolic disease. We aimed to gather the existing information on the association of nonalcoholic fatty liver disease with cardiac alterations, and to evaluate a possible correlation between them.


Systematic review of Medline searching results for original articles studying NAFLD and cardiac parameters until August 2018. A meta-analysis was conducted to each parameter of cardiac structure and function selected, using Review Manager 5.3 software. This study was conducted according to preferred reporting items for systematic reviews and meta-analysis (PRISMA).


A total of 16 studies met the eligibility criteria and were included in the meta-analysis. There was a significant association between nonalcoholic fatty liver disease and (1) higher left ventricle mass and ratios between left ventricle mass and both height and body surface area; (2) higher LVEDD; (3) higher left atrium diameter and ratio between left atrial volume and body surface area; (4) higher posterior wall and septum thickness; (5) lower E/A wave ratio; (6) higher E/E’ ratio; (7) longer deceleration time and (8) longer relaxation time.


NAFLD associates with adverse structural alterations and cardiac dysfunction. Our results highlight the importance of identifying NAFLD in patients with metabolic dysfunction as this may represent an additional contributor to cardiovascular risk.


NAFLD Fatty liver Metabolic syndrome Echocardiography Meta-analysis 



This work was supported by the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Program (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and the project NETDIAMOND (POCI-01-0145-FEDER-016385), supported by European Structural and Investment Funds, Lisbon’s Regional Operational Program 2020 and national funds from the Portuguese Foundation for Science and Technology.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary Table1
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Supplementary Figure4a
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Supplementary Figure 5a
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Supplementary Tables


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Marta Borges-Canha
    • 1
    • 2
    Email author
  • João Sérgio Neves
    • 1
    • 2
  • Diogo Libânio
    • 3
  • Madalena Von-Hafe
    • 1
  • Catarina Vale
    • 1
  • Miguel Araújo-Martins
    • 1
  • Ana Rita Leite
    • 1
  • Pedro Pimentel-Nunes
    • 1
    • 3
  • Davide Carvalho
    • 2
    • 4
  • Adelino Leite-Moreira
    • 1
  1. 1.Departamento de Cirurgia e FisiologiaFaculdade de Medicina da Universidade do PortoPortoPortugal
  2. 2.Serviço de Endocrinologia, Diabetes e MetabolismoCentro Hospitalar Universitário de São João, E.P.EPortoPortugal
  3. 3.Serviço de GastroenterologiaInstituto Português de Oncologia do PortoPortoPortugal
  4. 4.Instituto de Investigação e Inovação em Saúde (i3s)Faculdade de Medicina da Universidade do PortoPortoPortugal

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