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Electrocardiographic and echocardiographic changes in nonalcoholic fatty liver disease

Abstract

Context

Interactions between the heart and the liver have been described. The presence and severity of nonalcoholic fatty liver disease (NAFLD) was found to be associated with increased QTc interval and subclinical cardiac abnormalities.

Aim

The aim of this study was to evaluate the ECG and echocardiographic changes in patients with NAFLD and their correlation with disease severity.

Patients and methods

This study was conducted in Ain Shams University, Ain Shams Specialized, and Helwan University Hospitals in the period from May 2015 till May 2018. It was conducted on 50 patients with NAFLD and 50 controls. Clinical, laboratory, and ultrasonographic examinations were done for all included patients together with liver biopsies. ECG and echocardiography were also performed. Independent Student’s t-test, χ2-test, Fisher’s exact test, and Pearson’s correlation coefficient were used. Data were presented as mean±SD and number and percentage.

Results

Longer corrected QT was found in the NAFLD group in comparison with controls (406.6±26.8 and 380.0±24.5 ms, respectively). Significant correlation between QTc and liver size, grade of steatosis, and NAFLD activity score was found. Overall, 16 and 8% of patients with NAFLD had diastolic and valvular dysfunctions, respectively.

Conclusion

NAFLD is associated with significant QTc prolongation and structural heart changes, with significant correlation between QTc and disease severity.

References

  1. Targher G, Bertolini L, Rodella S, Tessari R, Zenari L, Lippi G, et al. Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 2007; 30:2119–2121.

    Article  CAS  PubMed  Google Scholar 

  2. Bhatia LS, Curzen NP, Calder FC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? Eur Heart J 2012; 33:1190–1200.

    Article  CAS  PubMed  Google Scholar 

  3. Targher G, Valbusa F, Bonapace S, Bertolini L, Zenari L, Pichiri I, et al. Association of nonalcoholic fatty liver disease with QTc interval in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2014; 24:663–669.

    Article  PubMed  Google Scholar 

  4. Targher G, Byrne CD. Circulating markers of liver function and cardiovascular disease risk. Arterioscler Thromb Vasc Biol 2015; 35:2290–2296.

    Article  CAS  PubMed  Google Scholar 

  5. Kleiner DE, Brunt EM, van Natta M, Behling C, Contos MJ, Cummings OW, et al. Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41:1313–1321.

    PubMed  Google Scholar 

  6. Brunt EM, Janney CG, di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999; 94:2467–2474.

    Article  CAS  PubMed  Google Scholar 

  7. Guntekın U, Gunes Y, Tuncer M, Gumrukcuoglu HA, Kaya Y. The effect of altitude on P-wave and QT duration and dispersion. Pacing Clin Electrophysiol 2008; 31:889–892.

    Article  PubMed  Google Scholar 

  8. Mantovani A, Ballestri S, Lonardo A, Targher G. Cardiovascular disease and myocardial abnormalities in nonalcoholic fatty liver disease. Dig Dis Sci 2015; 61:1246–1267.

    Article  Google Scholar 

  9. Gangemi S, Basile G, Merendino RA, Lo Balbo C, Mento A, Nicita-Mauro V, et al. Lower platelet count in healthy centenarians correlates with dispersion of the QT interval. Aging Clin Exp Res 2004; 16:169–171.

    Article  PubMed  Google Scholar 

  10. Strack C, Fessman D, Fenk S, Waldmann K, Kempinger S, Loew T, et al. QT prolongation is frequently observed in obesity with and without the metabolic syndrome and can be reversed by long term weight reduction. Eur Heart J 2013 34:4287.

    Article  Google Scholar 

  11. Campagna M, Locci E, Piras R, Noto A, Lecca LI, Pilia I, et al. Metabolomic patterns associated to QTc interval in shiftworkers: an explorative analysis. Biomarkers 2016; 21:607–613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Yenigun EC, Aypak C, Turgut D, Aydin MZ, Dede F. Effect of metabolic acidosis on QT intervals in patients with chronic kidney disease. Int J Artif Organs 2016; 39:272–276.

    Article  CAS  PubMed  Google Scholar 

  13. Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017; 66:1138–1153.

    Article  PubMed  Google Scholar 

  14. Goland S, Shimoni S, Zornitzki T, Knobler H, Azoulai O, Lutaty G, et al. Cardiac abnormalities as a new manifestation of nonalcoholic fatty liver disease: echocardiographic and tissue Doppler imaging assessment. J Clin Gastroenterol 2006; 40:949–955.

    Article  PubMed  Google Scholar 

  15. Kim NH, Park J, Kim SH, Kim YH, Kim DH, Cho GY, et al. Non-alcoholic fatty liver disease, metabolic syndrome and subclinical cardiovascular changes in the general population. Heart 2014; 100:938–943.

    Article  CAS  PubMed  Google Scholar 

  16. Bonci E, Chiesa C, Versacci P, Anania C, Silvestri L, Pacifico L. Association of nonalcoholic fatty liver disease with subclinical cardiovascular changes: a systematic review and meta-analysis. Biomed Res Int 2015; 2015:213737.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mantovani A, Pernigo M, Bergamini C, Bonapace S, Lipari P, Valbusa F, et al. Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease. Metabolism 2015; 64:879–887.

    Article  CAS  PubMed  Google Scholar 

  18. Markus MR, Baumeister SE, Stritzke J, Dörr M, Wallaschofski H, Völzke H, et al. Hepatic steatosis is associated with aortic valve sclerosis in the general population: the Study of Health in Pomerania (SHIP). Arterioscler Thromb Vasc Biol 2013; 33:1690–1695.

    Article  CAS  PubMed  Google Scholar 

  19. Aneni EC, Oni ET, Martin SS, Blaha MJ, Agatston AS, Feldman T, et al. Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk. J Hypertens 2015; 33:1207–1214.

    Article  CAS  PubMed  Google Scholar 

  20. Qian LY, Tu JF, Ding YH, Pang J, Che XD, Zou H, et al. Association of blood pressure level with nonalcoholic fatty liver disease in non-hypertensive population. Medicine (Baltimore) 2016; 95:e4293.

    Article  Google Scholar 

  21. Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. JAMA 2003; 289:3000–3004.

    Article  PubMed  Google Scholar 

  22. Nelson JE, Wilson L, Brunt EM, Yeh MM, Kleiner DE, Unalp-Arida A, et al. Relationship between pattern of hepatic iron deposition and histological severity in nonalcoholic fatty liver disease. Hepatology 2011; 53:448–457.

    Article  CAS  PubMed  Google Scholar 

  23. Patil R, Sood GK. Non-alcoholic fatty liver disease and cardiovascular risk. World J Gastrointest Pathophysiol 2017; 8:51–58.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon? Diabetologia 2008; 51:1947–1953.

    Article  CAS  PubMed  Google Scholar 

  25. Zeb I, Li D, Budoff MJ, Katz R, Lloyd-Jones D, Agatston A, et al. Nonalcoholic fatty liver disease and incident cardiac events: the Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol 2016; 67:1965–1966.

    Article  PubMed  Google Scholar 

  26. Nahandi MZ, Khoshbaten M, Ramazanzadeh E, Abbaszadeh L, Javardrashid R, Shirazi KM, et al. Effect of non-alcoholic fatty liver disease on carotid artery intima-media thickness as a risk factor for atherosclerosis. Gastroenterol Hepatol Bed Bench 2014; 7:55–62.

    PubMed  PubMed Central  Google Scholar 

  27. Sinn DH, Cho SJ, Gu S, Seong D, Kang D, Kim H, et al. Persistent nonalcoholic fatty liver disease increases risk for carotid atherosclerosis. Gastroenterology 2016; 151:481–488.e1.

    Article  PubMed  Google Scholar 

  28. Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med 2014; 11:562.

    Article  Google Scholar 

  29. Musso G, Cassader M, Cohney S, Pinach S, Saba F, Gambino R. Emerging liver-kidney interactions in nonalcoholic fatty liver disease. Trends Mol Med 2015; 21:645–662.

    Article  CAS  PubMed  Google Scholar 

  30. Marcuccilli M, Chonchol M. NAFLD and chronic kidney disease. Int J Mol Sci 2016; 17:562.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kwok RM, Toress DM, Harrison SA. Vitamin D and nonalcoholic fatty liver disease (NAFLD): is it more than just an association? Hepatology 2013; 58:1166–1174.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Shereen A. Saleh MD.

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Elsawaby, A.S., Al-Fiky, R.A., Mohamed, A.E. et al. Electrocardiographic and echocardiographic changes in nonalcoholic fatty liver disease. Egypt J Intern Med 31, 191–198 (2019). https://doi.org/10.4103/ejim.ejim_95_18

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  • DOI: https://doi.org/10.4103/ejim.ejim_95_18

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