Key result
NAFLD is linked to a ~1-SD higher E/e′ ratio, signaling worse LV diastolic function.
Why the study?
The cardiovascular implications of NAFLD have been associated with HFpEF, prompting an evaluation of the correlation between NAFLD and echocardiographic parameters of left ventricular diastolic function.
Does non-alcoholic fatty liver disease exposure increase left ventricular diastolic dysfunction and alter echocardiographic structural markers?
Meta-Analysis (n=906,650)
Does non-alcoholic fatty liver disease exposure increase left ventricular diastolic dysfunction and alter echocardiographic structural markers?
NAFLD is associated with echocardiographic signs of left ventricular diastolic dysfunction, supporting a pathophysiological link between fatty liver disease and the development of HFpEF.
NAFLD associated with diastolic dysfunction; extends observational HFpEF link but hypothesis-generating, needs prospective confirmation.
The cardiovascular implications of non-alcoholic fatty liver disease (NAFLD) have been associated with heart failure with preserved ejection fraction (HFpEF). The purpose of this review was to conduct a bibliographic search regarding the correlation between NAFLD and the echocardiographic parameters of left ventricular diastolic function. A systematic literature search was conducted in PubMed and Embase for original research data reporting on the association of NAFLD with diastolic function markers [E/e′, left atrial volume index (LAVi), left ventricular mass index (LVMi)]. Meta-analysis was performed using the meta and dmetar packages in R studio v.1.4.1106, with p < 0.05 values being considered significant. Results are expressed as the standardized mean difference (SMD) for continuous variables and as the odds ratio (OR) for categorical variables, with respective 95% confidence intervals (CI). Heterogeneity between studies was expressed with index Ι2. From the preliminary search, 2619 articles were found from which 31 studies were included in the final statistical analysis. The meta-analysis of 8 studies which reported on the prevalence of diastolic dysfunction showed that it was increased in patients with NAFLD (OR: 2.07, 95% CI 1.24–3.44 with p = 0.01, I2: 80% with p < 0.01). The meta-analysis of 21 studies showed significantly higher E/e′ in NAFLD patients (SMD 1.02, 95% CI 0.43–1.61 with p < 0.001, I2: 97% with p < 0.001). Individuals with NAFLD had increased LAVi (SMD: 0.87, 95% CI 0.38–1.37 with p < 0.001, I2: 96% with p < 0.001) and LVMi (SMD: 0.89, 95% CI 0.31–1.48 with p = 0.003, I2: 100% with p < 0.001). To conclude, in the meta-analysis of 31 observational studies, NAFLD patients were found to have affected left ventricular diastolic function, supporting the hypothesis of NAFLD being associated with HFpEF.
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Goliopoulou et al. (2023) conducted a meta-analysis in Non-alcoholic fatty liver disease (NAFLD) (n=906,650). Non-alcoholic fatty liver disease (NAFLD) vs. Absence of non-alcoholic fatty liver disease was evaluated on E/e′ ratio (SMD 1.02, 95% CI 0.43-1.61, p=<0.001). NAFLD exposure was associated with a significantly higher E/e′ ratio (SMD 1.02, p<0.001), indicating impaired left ventricular diastolic function compared to subjects without NAFLD.
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