Chang Kai-Chun, Su Tung-Hung, Wu Cho-Kai, Huang Shang-Chin, Tseng Tai-Chung, Hong Chun-Ming, Hsu Shih-Jer, Liu Chen-Hua, Yang Hung-Chih, Liu Chun-Jen, Kao Jia-Horng
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Eur J Heart Fail. 2025 Mar;27(3):512-520. doi: 10.1002/ejhf.3567. Epub 2025 Jan 8.
Metabolic dysfunction-associated steatotic liver disease (MASLD), defined by steatotic liver disease (SLD) and cardiometabolic factors, is increasing in prevalence, but its association with heart failure (HF) is unclear.
Patients with SLD without a history of HF from 2006 to 2021 were retrospectively included and were classified into MASLD and non-MASLD groups that were followed longitudinally. The primary outcome was the new development of HF, which was sub-classified by echocardiography. Multivariable and propensity score matching analyses were conducted to adjust for confounding factors. Overall, 26 676 patients with SLD were included, with a median age of 51 years and 71% classified as MASLD. During a median follow-up of 6 years, 429 (1.61%) patients developed HF, and 76% were HF with preserved ejection fraction (HFpEF). The risk of HF was significantly higher in patients with MASLD than in those without (sub-distribution hazard ratio [SHR] 2.59, 95% confidence interval [CI] 1.84-3.64) after adjustment of competing mortality. There was a dose-dependent increase in HF risks in patients with more cardiometabolic risk factors (SHR 1.12, 95% CI 1.04-1.22). MASLD was also associated with higher risk of HF-related hospitalization (SHR 2.30, 95% CI 1.31-4.04) and specifically, the risk of HFpEF (SHR 1.91, 95% CI 1.27-2.86). In propensity score-matched cohorts, MASLD was also associated with a 2.52-fold higher risk of HF.
In patients with SLD, those with MASLD show a higher risk of HF, specifically HFpEF. Future studies are warranted to validate the association between HF and MASLD.
代谢功能障碍相关脂肪性肝病（MASLD）由脂肪性肝病（SLD）和心脏代谢因素定义，其患病率正在上升，但其与心力衰竭（HF）的关联尚不清楚。
回顾性纳入2006年至2021年无HF病史的SLD患者，并分为MASLD组和非MASLD组，进行纵向随访。主要结局是HF的新发情况，通过超声心动图进行亚分类。进行多变量和倾向评分匹配分析以调整混杂因素。总体而言，纳入了26676例SLD患者，中位年龄为51岁，71%被归类为MASLD。在中位随访6年期间，429例（1.61%）患者发生HF，其中76%为射血分数保留的HF（HFpEF）。调整竞争死亡率后，MASLD患者发生HF的风险显著高于非MASLD患者（亚分布风险比[SHR]2.59，95%置信区间[CI]1.84 - 3.64）。心脏代谢风险因素越多的患者发生HF的风险呈剂量依赖性增加（SHR 1.12，95% CI 1.04 - 1.22）。MASLD还与HF相关住院的较高风险相关（SHR 2.30，95% CI 1.31 - 4.04），具体而言，与HFpEF的风险相关（SHR 1.91，95% CI 1.27 - 2.86）。在倾向评分匹配队列中，MASLD也与HF风险高2.52倍相关。
在SLD患者中，患有MASLD的患者发生HF的风险更高，尤其是HFpEF。未来有必要开展研究以验证HF与MASLD之间的关联。
