Metabolic dysfunction-associated steatotic liver disease is independently associated with early left ventricular impaired relaxation: a cross-sectional study of 3240 hospitalized patients

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Although previous research has suggested an association between MASLD and cardiac abnormalities, whether MASLD is independently associated with left ventricular impaired relaxation remains controversial, particularly in large Asian cohorts. This study aimed to investigate the association between MASLD and early left ventricular impaired relaxation, and to evaluate the impact of liver fibrosis risk on cardiac function. This cross-sectional study enrolled 3240 hospitalized patients at the Third People's Hospital of Yunnan Province between January 2023 and December 2025. MASLD was diagnosed based on imaging evidence of hepatic steatosis combined with at least one metabolic dysfunction criterion. Left ventricular structure and function were assessed using echocardiography. Early left ventricular impaired relaxation was defined as an E/A ratio < 1. Liver fibrosis risk was evaluated using the FIB-4 index. Multivariable logistic regression was performed to identify independent predictors of impaired relaxation. Given that E/A ratio alone cannot definitively diagnose diastolic dysfunction per current ASE/EACVI guidelines, we consistently describe our outcome as "impaired relaxation pattern" rather than formal diastolic dysfunction. Among 3240 participants (mean age 67.8 ± 14.2 years, 57.0% female), 1169 (36.1%) met the diagnostic criteria for MASLD. Compared with non-MASLD individuals, MASLD patients exhibited significantly lower E/A ratios (0.81 ± 0.24 vs. 0.88 ± 0.33, P = 0.007) and greater interventricular septal thickness (0.93 ± 0.14 cm vs. 0.90 ± 0.13 cm, P = 0.009). The prevalence of E/A < 1 was 52.3% (611/1169) in the MASLD group versus 38.7% (801/2071) in the non-MASLD group (P < 0.001). After adjusting for potential confounders, MASLD remained independently associated with early left ventricular impaired relaxation (OR 2.894, 95% CI 1.768–4.736, P < 0.001). Age-stratified analyses confirmed that the association persisted across all age groups. Among MASLD patients, those with intermediate-to-high fibrosis risk (FIB-4 ≥ 1.30) demonstrated worse relaxation (E/A ratio 0.76 ± 0.22 vs. 0.85 ± 0.27, P = 0.018) and higher left ventricular mass index (81.34 ± 15.28 g/m 2 vs. 75.89 ± 16.42 g/m 2 , P = 0.016) compared with those at low risk. MASLD is independently associated with early left ventricular impaired relaxation, with an association between higher fibrosis risk and more pronounced cardiac impairment. These findings highlight the importance of comprehensive cardiovascular evaluation in MASLD patients, particularly those with elevated fibrosis risk. Prospective studies with comprehensive echocardiographic assessment are needed to confirm these associations and establish temporal relationships.