Cardiovascular implications of MASLD: linking liver fibrosis to myocardial structure and function

Abstract Background/Introduction Metabolic dysfunction-associated fatty liver disease (MASLD) is an increasingly prevalent health concern. Cardiovascular disease (CVD) constitutes the leading cause of mortality among individuals with MASLD. Notably, patients with MASLD exhibit significant alterations in myocardial structure, primarily evidenced by impaired myocardial relaxation, which may correlate with CVD risk. Consequently, we hypothesize that in MASLD patients, the severity of liver fibrosis will positively correlate with the risk of CVD and structural changes in the myocardium. Purpose We hope to uncover the effects of myocardial changes on CVD development in MASLD patients, aiming to reduce mortality and morbidity. Methods We enrolled MASLD patients based on Delphi consensus, requiring imaging evidence of hepatic steatosis plus one risk factor: (1) obesity (BMI ≥ 23 kg/m²), (2) waist circumference, (3) type 2 diabetes, (4) hypertension, or (5) hyperlipidemia. We excluded patients who had drugs, genetic metabolic diseases, or heavy alcohol use-related steatosis. Participants who underwent liver biopsy were categorized by fibrosis score from 0 (healthy) to F4 (cirrhosis). Scores reflect increasing severity of scarring liver architecture: mild fibrosis at F1, moderate at F2, severe at F3, and cirrhosis at F4. We retrospectively compare the left and right ventricular systolic and left ventricular diastolic functions from MASLD patients who underwent liver biopsies at our hospital. Result Initially, we enrolled 131 MASLD subjects. Among them, 114 had a good cardiac echo image. Participants in the F1-2 (n=38) and F3-4 (n=37) groups are significantly older and heavier than those in the F0 (no fibrosis, n=39) group. Besides, the prevalence of diabetes (DM) and hypertension is higher in the F1-2 and F3-4 groups compared to F0. The left and right ventricular systolic function differ between these three groups. The LV mass index is significantly higher in the F1-2 and F3-4 groups compared to F0. The diastolic parameter, mean E/e’, is lower in F0 than in F1-2/3-4 groups, and the LA reservoir strain and LA stiffness are significantly higher in F0 than in F1-2/F3-4 groups. Conclusions Severe MASLD liver fibrosis (F1-4) is associated with increased age, weight, diabetes, hypertension, and left ventricular diastolic dysfunction.