Published online Oct 26, 2024. doi: 10.4330/wjc.v16.i10.580
Revised: August 28, 2024
Accepted: September 19, 2024
Published online: October 26, 2024
Processing time: 204 Days and 3.6 Hours
Metabolic dysfunction-associated steatotic liver disease (MASLD), particularly in the presence of liver fibrosis, increases the risk of cardiovascular morbidity and mortality, but the nature of the cardio-hepatic interaction in the context type 2 diabetes mellitus (T2DM) is not fully understood.
To evaluate the changes in cardiac morphology and function in patients with T2DM and MASLD-associated liver fibrosis.
T2DM patients with MASLD underwent a medical evaluation that included an assessment of lifestyle, anthropometric measurements, vital signs, an extensive laboratory panel, and a standard echocardiography. Liver fibrosis was evaluated using two scores [Fibrosis-4 (FIB4) and Non-alcoholic fatty liver disease-Fibrosis Score (NFS)], and subjects were classified as having advanced fibrosis, no fibrosis, or an indeterminate risk. The correlations between structural and functional cardiac parameters and markers of liver fibrosis were evaluated through bivariate and multiple regression analyses. Statistical significance was set at P < 0.05.
Data from 267 T2DM-MASLD subjects with complete assessment was analyzed. Patients with scores indicating advanced fibrosis exhibited higher interventricular septum and left ventricular (LV) posterior wall thickness, atrial diameters, LV end-systolic volume, LV mass index (LVMi), and epicardial adipose tissue thickness (EATT). Their mean ejection fraction (EF) was significantly lower (49.19% ± 5.62% vs 50.87% ± 5.14% vs 52.00% ± 3.25%; P = 0.003), and a smaller proportion had an EF ≥ 50% (49.40% vs 68.90% vs 84.21%; P = 0.0017). Their total and mid LV wall motion score indexes were higher (P < 0.05). Additionally, they had markers of diastolic dysfunction, with a higher E/e’ ratio [9.64 ± 4.10 vs 8.44 (2.43-26.33) vs 7.35 ± 2.62; P = 0.026], and over 70% had lateral e’ values < 10 cm/second, though without significant differences between groups. In multiple regression analyses, FIB4 correlated with left atrium diameter (LAD; β = 0.044; P < 0.05), and NFS with both LAD (β = 0.039; P < 0.05) and right atrium diameter (β = 0.041; P < 0.01), Moreover, LVMi correlated positively with age and EATT (β = 1.997; P = 0.0008), and negatively with serum sex-hormone binding protein (SHBP) concentrations (β = -0.280; P = 0.004). SHBP also correlated negatively with LAD (β = -0.036; P < 0.05).
T2DM patients with markers of MASLD-related liver fibrosis exhibit lower EF and present indicators of diastolic dysfunction and cardiac hypertrophy. Additionally, LVMi and LAD correlated negatively with serum SHBP concentrations.
Core Tip: Metabolic dysfunction-associated steatotic liver disease (MASLD) is frequently associated with type 2 diabetes mellitus (T2DM), and both conditions are important risk factors for cardiovascular disease. However, the nature of the cardio-liver interaction, particularly in patients with T2DM, is not completely elucidated. In this study we found that T2DM patients with MASLD-associated fibrosis, quantified by accessible scores (Fibrosis-4 and Non-alcoholic fatty liver disease-Fibrosis Score), present markers of systolic and diastolic dysfunction, as well as cardiac hypertrophy, particularly increased left atrial diameter. The left ventricular mass index and left atrial dimension also correlated negatively with serum concentrations of sex-hormone binding protein, which may serve as a valuable prognostic biomarker. Mechanistic studies that explain the correlations between liver fibrosis and cardiac remodeling in MASLD patients, both with and without T2DM, are greatly needed.