Oral Presentation ANZOS Annual Scientific Meeting 2021

Advanced liver fibrosis in adults with obesity is associated with alterations in cardiac structure and function (#117)

Matthew Tran 1 , Ramy Bishay 1 2 , Annette MacDonald 2 , Amy Phu 3 , Golo Ahlenstiel 1 3 4 , Timothy Tan 1 5
  1. School of Medicine, Western Sydney University, Sydney, NSW, Australia
  2. Blacktown Metabolic and Weight Loss Program, Department of Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  3. Storr Liver Centre, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
  4. Department of Gastroenterology and Hepatology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
  5. Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia

Objectives: Adults with obesity have increased cardiovascular disease risk and mortality. Alterations in cardiac structure and function have been reported in adults with obesity, independent of known cardiac disease. However, the factors modulating these alterations in obesity remain unclear. Non-alcoholic fatty liver disease (NAFLD) has also been associated with obesity, however the association between advanced liver fibrosis due to NAFLD, and cardiac remodelling and dysfunction, has not been well characterised. The aim of our study was to examine the relationship between liver fibrosis and measures of cardiac structure and function.

Methods: Consecutive patients attending the Metabolic and Weight Loss Clinic at Blacktown Hospital (2017-2019) with a comprehensive transthoracic echocardiography were included. Patients were referred by their primary care physician and had a BMI > 35 kg/m2 with co-existent type 2 diabetes or BMI > 40 kg/m 2 with two obesity complications. A range of clinical, biochemical, and echocardiographic parameters of cardiac structure and function were examined in patients with advanced liver fibrosis (defined by a NAFLD Fibrosis Score >0.675) vs those without advanced liver fibrosis.

Results: Of 158 included patients (27.8% male, mean age 48.6 years, mean BMI 48.0kg/m2), 65 had advanced liver fibrosis and 93 did not. Patients with advanced liver fibrosis had higher mean interventricular septum thickness (p=0.0019), larger left ventricular mass (p=0.029), and larger right ventricular basal diameter (p=0.020). Advanced liver fibrosis was also associated with an increased average E/e’ (p=0.026), longer deceleration time (p=0.001), and a reduced septal e’ (p=0.049), lateral e’ (p=0.003) and E/A ratio (p=0.012), suggestive of impaired
diastolic function. There were no significant differences between left and right ventricular systolic function between both groups.

Conclusions: Advanced liver fibrosis is associated with changes in cardiac structure and left ventricular diastolic function. Further research is required to corroborate the associations identified in this study.