Echocardiography and NAFLD (non-alcoholic fatty liver disease)

• Published in: International journal of cardiology 2016-10, Vol.221, p.275-279
• Main Authors: Trovato, Francesca M, Martines, Giuseppe F, Catalano, Daniela, Musumeci, Giuseppe, Pirri, Clara, Trovato, Guglielmo M
• Format: Article
• Language: English
• Subjects: Adult; Cardiovascular; Diastolic function; Diet, Mediterranean; Echocardiography; Echocardiography, Doppler - methods; Exercise - physiology; Female; Humans; Liver steatosis; Male; Mediterranean diet; Middle Aged; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Non-alcoholic Fatty Liver Disease - physiopathology; Non-alcoholic Fatty Liver Disease - therapy; Physical activity; Risk Reduction Behavior; Systolic function
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.06.180

Abstract Non-alcoholic-fatty-liver-disease (NAFLD) is associated with atherosclerosis, increased cardiovascular risks and mortality. We investigated if, independently of insulin resistance, diet, physical activity and obesity, fatty liver involvement has any relationship with echocardiographic measurements in NAFLD. Patients and methods 660 NAFLD and 791 non-NAFLD subjects, referred to the same out-patients medical unit for lifestyle-nutritional prescription, were studied. Congestive heart failure, myocardial infarction, malignancies, diabetes mellitus, extreme obesity, underweight-bad-nourished subjects and renal insufficiency were exclusion criteria. Liver steatosis was assessed by Ultrasound-Bright-Liver-Score (BLS), left ventricular ejection fraction (LVEF), trans-mitral E/A Doppler ratio (diastolic relaxation) and left ventricular myocardial mass (LVMM/m2 ) by echocardiography. Doppler Renal artery Resistive Index (RRI), insulin resistance (HOMA) and lifestyle profile were also included in the clinical assessment. Results LVMM/m2 is significantly greater in NAFLD, 101.62 ± 34.48 vs. 88.22 ± 25.61, p < 0.0001 both in men and in women. Ejection fraction is slightly greater only in men without NAFLD; no significant difference was observed for the E/A ratio. BMI (30.42 ± 5.49 vs. 24.87 ± 3.81; p < 0.0001) and HOMA (2.90 ± 1.70 vs. 1.85 ± 1.25; p: 0.0001) were significantly greater in NAFLD patients. By Multiple-Linear-Regression, NAFLD and unhealthy dietary profile are associated also in lean non-diabetic subjects with lower systolic function, independently of BMI, dietary profile, physical activity, RRI and insulin resistance. Conclusion NAFLD may be a meaningful early clue suggestive of diminishing heart function, with similar determining factors. NAFLD is amenable to management and improvement by lifestyle change counseling, addressing a dual target: reducing fatty liver, which is easily monitored by Ultrasound, and, independently, maintaining a normal heart function.