Mantovani Alessandro, Morandin Riccardo, Sani Elena, Fiorio Veronica, Shtembari Emigela, Bonapace Stefano, Petta Salvatore, Polyzos Stergios A, Byrne Christopher D, Targher Giovanni
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
Division of Cardiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Negrar, Italy.
Liver Int. 2025 Jan;45(1):e16128. doi: 10.1111/liv.16218.
Studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and an increased risk of developing atrial fibrillation (AF). However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain.
In this systematic review and meta-analysis, we searched three large electronic databases using predefined keywords to identify cohort studies (published up to 30 September 2024) in which MASLD was diagnosed by liver biopsy, imaging methods, International Classification of Diseases (ICD) codes, or blood-based scores. The primary outcome was the occurrence of AF based on ICD codes, medical records, or electrocardiograms. Meta-analysis was performed using random-effects modelling.
We identified 16 retrospective cohort studies with aggregate data on ~19.5 million individuals followed for a median of 7.2 years. MASLD was significantly associated with an increased risk of developing incident AF (random-effects hazard ratio 1.20, 95% CI 1.10-1.32; I = 92%). This risk did not appear to further increase with the severity of liver fibrosis (n = 3 studies; random-effects hazard ratio 1.22, 95% CI 1.18-1.26; I = 10%). The risk of AF remained significant even after adjusting for age, sex, body mass index, hypertension, Type 2 diabetes or other cardiometabolic risk factors. Sensitivity analyses did not modify these findings. The funnel plot and Egger's test showed no significant publication bias.
This updated and comprehensive meta-analysis provides evidence that MASLD is significantly associated with an increased long-term risk of developing incident AF. Further research is required to better decipher the link between MASLD and increased AF incidence.
研究报告了代谢功能障碍相关脂肪性肝病（MASLD）与发生心房颤动（AF）风险增加之间的关联。然而，风险的程度以及该风险是否随MASLD的严重程度而变化仍不确定。
在这项系统评价和荟萃分析中，我们使用预定义的关键词搜索了三个大型电子数据库，以识别队列研究（截至2024年9月30日发表），其中MASLD通过肝活检、成像方法、国际疾病分类（ICD）编码或基于血液的评分进行诊断。主要结局是基于ICD编码、病历或心电图的AF发生情况。使用随机效应模型进行荟萃分析。
我们确定了16项回顾性队列研究，汇总数据涉及约1950万人，中位随访时间为7.2年。MASLD与发生新发AF的风险显著增加相关（随机效应风险比1.20，95%CI 1.10 - 1.32；I² = 92%）。这种风险似乎并未随着肝纤维化严重程度的增加而进一步升高（n = 3项研究；随机效应风险比1.22，95%CI 1.18 - 1.26；I² = 10%）。即使在调整年龄、性别、体重指数、高血压、2型糖尿病或其他心血管代谢危险因素后，AF风险仍然显著。敏感性分析未改变这些结果。漏斗图和Egger检验显示无显著发表偏倚。
这项更新的综合荟萃分析提供了证据，表明MASLD与发生新发AF的长期风险显著增加相关。需要进一步研究以更好地解读MASLD与AF发病率增加之间的联系。
