Nonalcoholic Steatohepatitis is Associated with Cardiac Remodeling and Dysfunction

Objective: Preliminary data suggest that nonalcoholic fatty liver disease is associated with early heart failure (HF). However, whether nonalcoholic steatohepatitis (NASH) is directly associated with echocardio-graphic changes in cardiac structure or function remains unknown. Methods: A retrospective cohort was identified of individuals (N=65) without known heart disease, undergoing elective bariatric surgery with perioperative liver biopsy, and available recent transthoracic echocardiography (TTE). TTE measures were evaluated by NASH status using correlation coefficients, ANOVA, and linear regression, accounting for cardiometabolic factors. Results: Median age was 47 years; 22% (n=14) had NASH. NASH patients had increased median left atrial (LA) volume (28.6 mL/m(2) vs. 24.8 mL/m(2); P < 0.0001) and left ventricular (LV) mass (82.6 g/m(2) vs. 78.6 g/m(2); P < 0.0001), indexed for height. NASH was inversely correlated with indices of diastolic function, including septal E' (r= -0.90 [95% CI: -1.21 to -0.42]; P=0.020) and E:A (r= -0.31 [95% CI: -0.51 to -0.09]; P=0.037). In adjusted analyses, NASH remained associated with increased LV mass index (beta(1) = 7.16 [SE: 4.95]; P=0.001) and LA volume index (beta(1) = 0.19 [SE:0.08]; P=0.001) and reduced lateral and septal E' (beta(1) = -0.91, P=0.015; beta(1) = -0.89, P=0.047, respectively). Conclusions: In this bariatric cohort, NASH was associated with changes in myocardial structure and in load-dependent indices of LV diastolic function, suggestive of subclinical HF.