Table 2.

Non-alcoholic fatty liver disease and cardiac structure and function

Ref.	Methods	Results
Goland et al[34]	38 patients with NAFLD, < 55 years of age and normal exercise test, were compared with an age and sex-matched control group TT echo study including TDI	Patients with NAFLD have mildly altered LV geometry (Increased thickness of the intraventricular septum, posterior wall, and larger LV mass), and early features of left ventricular diastolic dysfunction. Early diastolic velocity on TDI is the only index identifying the patients with NAFLD and metabolic syndrome
Fallo et al[35]	Left ventricular morphology/function, metabolic parameters and NAFLD in 86 never-treated essential hypertensive patients subdivided into two subgroups according to the presence (n = 48) or absence (n = 38) of NAFLD at ultrasonography	Patients with NAFLD had similar prevalence of LVH compared to patients without NAFLD, but a higher prevalence of diastolic dysfunction
Fotbolcu et al[36]	35 non-diabetic, normotensive NAFLD patients and 30 controls. TT echo and TDI performed	Patients with NAFLD have impaired LV systolic and diastolic function and lower E' (early diastolic velocity on TDI)s. TDI systolic velocity (S' on TDI) values were lower in NAFLD
Bonapace et al[37]	50 patients with type 2 DM, US diagnosed NAFLD. 32 patients (64%) with NAFLD, compared to other 18 patients. TT echo and TDI performed	Early features of LV diastolic dysfunction may be detected in patients with type 2 diabetes and NAFLD
Kim et al[38]	1886 participants without CVS disease. Stratified by the presence or absence of CT-diagnosed NAFLD, MetS. Assessed by TDI, carotid ultrasound and baPWV	Subjects with both NAFLD and MetS had a higher E/Ea ratio and baPWV, and lower TDI Ea velocity (P < 0.001). Subjects with either NAFLD or MetS also showed significant differences in TDI Ea velocity and baPWV (P < 0.05). No significant differences of CIMT values
Ozveren et al[39]	59 patients with NAFLD and 22 healthy subjects as controls. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls	The heart rate recovery index is deteriorated in patients with NAFLD
Petta et al[41]	Anthropometric, biochemical and metabolic of 147 consecutive biopsy-proven NAFLD cases	Diastolic posterior-wall thickness, left ventricular mass, relative wall thickness, left atrial volume, as well as ejection fraction, lower lateral TDI e', E/A ratio and epicardial fat linked to severe liver fibrosis
Mantovani et al[42]	116 consecutive patients with hypertension and type 2 diabetes. US diagnosed NAFLD, LVH diagnosed by TT echo	LVH higher among diabetic patients with NAFLD. NAFLD is associated with LVH independently of classical CVS risk factors
Singh et al[43]	IHTG content (magnetic resonance spectroscopy), insulin sensitivity and β-cell function, and left ventricular function (speckle tracking echocardiography) among 3 groups adolescents: (1) lean-BMI = 20 ± 2 kg/m2); (2) obese with normal IHTG content, BMI = 35 ± 3 kg/m2); and (3) obese with increased IHTG content, BMI = 37 ± 6 kg/m2	The disposition index (β-cell function) and insulin sensitivity index were approximately 45% and about 70% lower, respectively, and whole body insulin resistance, was about 60% greater, in obese than in lean subjects, and about 30% and about 50% lower and about 150% greater, respectively, in obese subjects with NAFLD than those without NAFLD (P < 0.05 for all)
Sert et al[44]	80 obese adolescents and 37 lean subjects. NAFLD based on elevated transaminases	LV mass and CIMT higher in both NAFLD and non-NAFLD obese patients compared to lean children
Pacifico et al[45]	TDI, and MRI for measurement of HFF and abdominal fat mass distribution in 108 obese children, 54 with (HFF ≥ 5%) and 54 without NAFLD, and 18 lean healthy subjects. 41 of the children with NAFLD underwent liver biopsy	Asymptomatic obese children with NAFLD exhibit features of early LV diastolic and systolic dysfunction, and are more severe in those with NASH
Kocabay et al[46]	55 biopsy-proven NAFLD patients and 21 healthy controls. Categorized as simple steatosis, borderline NASH, definitive NASH	LA-Res, LA-Pump and LA-SR(A) were lower in the NAFLD vs control. LA-Res and LA-pump significantly lower in NAFLD subgroups. There were significant differences in LA-SR(A) between healthy controls compared with simple steatosis and borderline
Karabay et al[47]	55 NAFLD patients and 21 healthy controls. Biopsy-proven NAFLD. Categorized as simple steatosis, borderline NASH, definitive NASH. All had echocardiography	Patients with NAFLD and its subgroups have evidence of subclinical myocardial dysfunction in relation to the presence of insulin resistance
Gianotti et al[48]	171 subjects aged > than 65 yr. US diagnosed NAFLD and TT echo	NAFLD had borderline significant association with higher end-diastolic thicknesses of left-ventricle edPW and right-ventricle wall
Perseghin et al[49]	21 nondiabetic men with or without fatty liver matched anthropometrically features assessed by (1) cardiac MRI; (2) cardiac P-MRS; and (3) hepatic H-MRS to assess quantitatively the IHF content	In newly diagnosed patients with fatty liver, fat accumulated in the epicardial area and despite normal LV morphological features, systolic and diastolic functions, there was abnormal LV energy metabolism
Hallsworth et al[50]	19 adults with NAFLD were age-, sex-, and BMI-matched to healthy controls. Cardiac structure and function assessed by high-resolution cardiac MRI. High-energy phosphate metabolism was assessed using[31] P-MRS	Adults with NAFLD had significantly thicker left ventricular walls at systole and diastole than those without fatty liver and showed decreased longitudinal shortening. The eccentricity ratio was significantly higher in the NAFLD group indicating concentric remodelling. Peak whole wall strain was higher in the NAFLD, as was peak endocardial strain. Cardiac metabolism, measured by PCr/ATP ratio, was not altered in NAFLD

NAFLD: Non-alcoholic fatty liver disease; TDI: Tissue Doppler imaging; DM: Diabetes mellitus; CT: Computed tomography; MetS: Metabolic syndrome; baPWV: Brachial-ankle pulse wave velocity; BMI: Body mass index; IHTG: Intrahepatic triglyceride; HFF: Hepatic fat fraction; NASH: Non-alcoholic steatohepatitis; MRI: Magnetic resonance imaging; MRS: Magnetic resonance spectroscopy; CIMT: Carotid intima-media thickness; TT: Transthoracic; US: Ultrasound; CVS: Cardiovascular; LV: Left ventricular; LVH: Left ventricular hypertrophy.