Nonalcoholic fatty liver disease and vascular disease: State-of-the-art

Table 2 Studies of the impaired left ventricular function and disturbance of rhythm in patients with nonalcoholic fatty liver disease

Ref.	Study design	Study population	Study size	Diagnosis of NAFLD	Cardiac parameters examined	Results
Left ventricular function
Goland et al[78], 2006	Retrospective, Case-control study, Hospital-based	NAFLD vs control	38 NAFLD 25 non-NAFLD	US or histology	Complete echocardiographic study, TDI, peak velocities of E and A diastolic filling, E/A ratio, Vp, E', and S' of mitral annulus	NAFLD patients had increased thickening of the intraventricular septum and posterior, lower E diastolic filling velocity, lower E/A ratio, longer, lower Vp and lower E' No differences were found according to LV systolic function
Lautamaki et al[79] 2006	Retrospective, Case-control study, Hospital-based	Patients with type 2 diabetes and CVD	28 low liver fat 27 high liver fat Matched for age, BMI, fasting glucose	H-MRS	Positron emission tomography. Myocardial perfusion was measured with[15O]H2O and myocardial and skeletal muscle glucose uptake with 2-deoxy-2-[18F]fluoro-D-glucose during hyperinsulinemic euglycemia	Liver fat content is independently associated with impaired myocardial metabolism
Fallo et al[80] 2009	Retrospective, Case-control study, Hospital-based	Never-treated essential hypertensive patients	48 NAFLD 38 non-NAFLD Matched for sex, age and blood pressure levels	US	Complete echocardiographic study: TDI, peak velocities of E and A diastolic filling, E/A ratio, Vp, E', and S' of mitral annulus	NAFLD patients had increased prevalence of left ventricular hypertrophy , diastolic dysfunction that increased according to the degree of NAFLD
Perseghin et al[81] 2008	Retrospective, Case-control study, Hospital-based	Young non-diabetic men	21 fatty liver 21 non fatty liver Matched for age, BMI, blood pressure levels, lipid values	H-MRS	MRI and MRS	No difference in morphological parameters of the LV, systolic and diastolic functions NAFLD patients had reduced values of PCr/ATP ratio
Bonapace et al[17] 2012	Retrospective, Case-control study, Hospital-based	Patients with type 2 diabetes	32 NAFLD 18 non-NAFLD Matched for age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, medication use	US	Complete echocardiographic study, TDI, peak velocities of E and A diastolic filling, E/A ratio, Vp, E', and S' of mitral annulus	NAFLD patients had lower E', tissue velocity, higher E-to-e' ratio, higher time constant of isovolumic relaxation, higher LV-end diastolic pressure (EDP), higher LV EDP/end diastolic volume No difference in morphological parameters of the LV, systolic functions
Hallsworth et al[82] 2013	Retrospective, Case-control study, Hospital-based	NAFLD and healthy controls	19 NAFLD 19 non-NAFLD Matched for age, sex, BMI, weight, and body surface area vs control	H-MRS	MRI and MRS	NAFLD patients had thicker left ventricular walls at systole and diastole, decreased longitudinal shortening, higher concentric remodelling. No difference in PCr/ATP ratio
Disturbance of cardiac rhythm
Targher et al[19] 2013	Prospective, Hospital-based	Type 2 diabetes	281 NAFLD 119 non-NAFLD Adjustments for age, sex, hypertension and electrocardiographic features	US	12-lead electrocardiogram	NAFLD was associated with an increased risk of incident AF

A: Late; BMI: Body mass index; E: Early; E': Early diastolic velocity; H-MRS: Proton magnetic resonance spectroscopy; cardiac MRI: Magnetic resonance imaging; MRS: 31P-MR spectroscopy; NAFLD: Nonalcoholic fatty liver disease; PCr/ATP ratio: Phosphocreatine/adenosine triphosphate ratio; S': Systolic velocity; TDI: Tissue Doppler imaging; US: Ultrasonography; Vp: Flow propagation velocity; AF: Atrial fibrillation.