Key result
Elevated FIB-4 scores in MASLD link to worse diastolic function, including higher LAVi.
Why the study?
The Fibrosis-4 (FIB-4) score assesses liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) and predicts heart failure risk. However, its relationship with early diastolic dysfunction in asymptomatic MASLD patients free of structural heart disease and systolic dysfunction needed evaluation.
Does a higher Fibrosis-4 (FIB-4) score correlate with early diastolic dysfunction on echocardiography in asymptomatic middle-aged adults with metabolic dysfunction-associated steatotic liver disease (MASLD)?
Cross-Sectional (n=4,056)
No
Does a higher Fibrosis-4 (FIB-4) score correlate with early diastolic dysfunction on echocardiography in asymptomatic middle-aged adults with metabolic dysfunction-associated steatotic liver disease (MASLD)?
The Fibrosis-4 (FIB-4) score is independently associated with echocardiographic markers of early diastolic dysfunction in asymptomatic middle-aged adults with MASLD, suggesting its utility as a routine blood-based marker for subclinical cardiac dysfunction.
Supports FIB-4 for identifying subclinical diastolic dysfunction in MASLD; leaves open its incremental value over echocardiography alone.
Background Metabolic dysfunction-associated steatotic liver disease (MASLD) shares key pathophysiological mechanisms with cardiovascular disease. The Fibrosis-4 (FIB-4) score is a well-established tool for assessing liver fibrosis in MASLD. The FIB-4 score is known to be useful for predicting the risk of heart failure as well as advanced liver disease. We evaluated the relationship between FIB-4 and early diastolic dysfunction in MASLD patients free of structural heart disease, systolic dysfunction, and cardiac symptoms. Methods We analyzed consecutive middle-aged adults (aged 30–60 years) who underwent both echocardiography and liver ultrasonography at our Hospital between April 2020 and February 2026. After excluding those with significant echocardiographic abnormalities, a total of 4,056 participants were finally included in the analysis. All analyzed participants maintained a left ventricular ejection fraction (LVEF) greater than 50% and were free of significant valvular disease. MASLD was diagnosed according to the Korean Association for the Study of the Liver (KASL) guidelines, which define overweight as a BMI ≥ 23 kg/m2 and waist circumference thresholds of ≥ 90 cm for men and ≥ 80 cm for women. FIB-4 scores were stratified into low-risk (< 1.3), intermediate-risk (1.3–2.67), and high-risk (> 2.67) groups. Results Among the study population, 61.0% (n=2,476) presented with fatty liver, of which 94.9% (n=2,349) met the diagnostic criteria for MASLD. In the MASLD cohort, the mean age was 45.4 ± 8.3 years and 17.4% were female. Metabolic abnormalities were highly prevalent, with 87.6% being overweight or having increased waist circumference, 67.4% having glucose metabolism dysfunction, and 45.5% having elevated blood pressure. The mean FIB-4 score was 1.69 ± 0.80, with 42.9% in the low-risk group and 57.1% in the combined intermediate-to-high-risk groups. Correlation analysis revealed that the FIB-4 score significantly correlated with age (R=0.046,p<0.05), LA volume index:LAVi (R=0.090,p<0.001), e' velocity (R=-0.053,p<0.05), LV mass index (R=0.131,p<0.001), E/e’ ratio (R=0.046,p<0.05), and deceleration time (R=0.090,p<0.001). Compared to the low-risk group, the intermediate-to-high-risk groups exhibited significantly higher LAVi (22.6 vs. 21.3 p<0.001), TRjet peak velocity (2.00 vs. 1.98 p<0.05) and lower e'(8.60 vs. 8.84 p<0.01). Furthermore, the FIB-4 index remained a significant independent predictor of the E/e’ ratio even after adjusting for age, sex, and the number of metabolic syndrome components. Conclusion The FIB-4 score is significantly associated with early-stage cardiac dysfunction in asymptomatic individuals with MASLD. Since the FIB-4 score can be easily calculated from routine blood tests, it may serve as a clinically valuable marker for the early detection of subclinical cardiac dysfunction in this population.
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Ryu et al. (2026) conducted a cross-sectional in Metabolic dysfunction-associated steatotic liver disease (MASLD) (n=4,056). Fibrosis-4 (FIB-4) score (intermediate-to-high-risk ≥1.3) vs. Low-risk FIB-4 score (<1.3) was evaluated on Early diastolic dysfunction parameters (LAVi, e' velocity, E/e' ratio) (R 0.090, p=<0.001). Higher FIB-4 scores (≥1.3 vs <1.3) in MASLD patients were associated with worse diastolic parameters, including higher LAVi (22.6 vs 21.3, p<0.001) and lower e' velocity (8.60 vs 8.84, p<0.01).
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