Department of Internal Medicine Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Atherosclerosis. 2018 May;272:137-144. doi: 10.1016/j.atherosclerosis.2018.03.027. Epub 2018 Mar 17.
Nonalcoholic fatty liver disease (NAFLD) may be associated with a wide spectrum of cardiac abnormalities, which share many metabolic risk factors. This study aimed to evaluate whether NAFLD is associated with left ventricular (LV) diastolic dysfunction independent of other classical risk factors.
A total of 3300 subjects (mean age, 54.1 years; 62.9% men), who underwent echocardiography and hepatic ultrasonography, were enrolled. LV diastolic dysfunction was diagnosed and graded using conventional and Doppler echocardiographic assessments. NAFLD was diagnosed by ultrasonographic findings without any evidence of significant alcohol consumption or viral hepatitis, other liver diseases, or medication provoking fatty liver. Advanced fibrosis was defined as having intermediate-high probability for advanced fibrosis using the NAFLD fibrosis score.
The prevalence of LV diastolic dysfunction was 35.1%. NAFLD had a higher prevalence and severity of LV diastolic dysfunction. The prevalence rates of LV diastolic dysfunction were significantly increased according to the NAFLD fibrosis grade (30.4% for no-NAFLD, 35.2% for NAFLD without advanced fibrosis and 57.4% for NAFLD with advanced fibrosis, p < 0.001). Multivariable analysis showed that NAFLD was associated with a 29% increase in the risk of diastolic dysfunction compared with controls (odds ratio [OR] 1.29; 95% confidence interval [CI] 1.07-1.60). There was significant interaction between obesity (BMI < 25 kg/mvs. ≥ 25 kg/m) and advanced fibrosis for LV diastolic dysfunction. A significant, incrementally increased risk of diastolic dysfunction according to the fibrosis grade was more pronounced in the non-obese population [adjusted OR (95% CI), 1.40 (1.06-1.84) for NAFLD without advanced fibrosis, 1.44 (0.95-2.17) for NAFLD with advanced fibrosis vs. no NAFLD, P for trend = 0.022] compared with the obese population (p for trend = 0.081), independent of other well-defined risk factors.
NAFLD was associated with increased risk for LV diastolic dysfunction. In addition, an incrementally increased risk for LV diastolic dysfunction according to fibrosis grade was prominent in the non-obese population.
非酒精性脂肪性肝病（NAFLD）可能与广泛的心脏异常有关，这些异常与许多代谢危险因素共享。本研究旨在评估非酒精性脂肪性肝病是否与左心室（LV）舒张功能障碍有关，而与其他经典危险因素无关。
共纳入 3300 例接受超声心动图和肝脏超声检查的受试者（平均年龄 54.1 岁，62.9%为男性）。采用常规和多普勒超声心动图评估诊断和分级 LV 舒张功能障碍。NAFLD 通过超声检查诊断，无明显酒精摄入或病毒性肝炎、其他肝病或药物引起的脂肪肝证据。使用 NAFLD 纤维化评分，将高级纤维化定义为具有中高度进展性纤维化的可能性。
LV 舒张功能障碍的患病率为 35.1%。NAFLD 的患病率和 LV 舒张功能障碍的严重程度更高。根据 NAFLD 纤维化分级，LV 舒张功能障碍的患病率显著增加（无 NAFLD 为 30.4%，无高级纤维化的 NAFLD 为 35.2%，有高级纤维化的 NAFLD 为 57.4%，p<0.001）。多变量分析显示，与对照组相比，NAFLD 患舒张功能障碍的风险增加 29%（比值比[OR] 1.29；95%置信区间[CI] 1.07-1.60）。肥胖（BMI<25kg/m2与 BMI≥25kg/m2）与高级纤维化之间存在显著的交互作用，LV 舒张功能障碍。根据纤维化分级，舒张功能障碍的风险呈显著递增趋势，在非肥胖人群中更为明显[调整后的比值比（95%CI），无高级纤维化的 NAFLD 为 1.40（1.06-1.84），有高级纤维化的 NAFLD 为 1.44（0.95-2.17），与无 NAFLD 相比，P趋势值=0.022]，与肥胖人群相比（P趋势值=0.081），独立于其他明确的危险因素。
NAFLD 与 LV 舒张功能障碍的风险增加有关。此外，根据纤维化分级，LV 舒张功能障碍的风险呈递增趋势，在非肥胖人群中更为明显。
