Evaluation of subclinical cardiac damage in biopsy-proven nonalcoholic fatty liver disease: a systematic review and meta-analysis

Authors Artemis Christina Oikonomidou, Ioannis Doundoulakis, Christina Antza, Georgios Kalopitas, Theodoros Dardavessis, Michael Chourdakis.


Background Data on the association of nonalcoholic fatty liver disease (NAFLD) with subclinical cardiac damage are scanty. We performed a systematic review to provide comprehensive information on subclinical cardiac alterations among NAFLD subjects.

Methods PubMed and the Cochrane Library were searched to identify studies comparing subclinical cardiac damage between NAFLD and healthy adults. We also searched PROSPERO to check for any similar meta-analysis in progress in order to avoid duplication with our study. Conference abstracts and the reference lists of relevant studies and systematic reviews were perused. The Newcastle- Ottawa quality assessment scale for case-control and cohort studies were used to assess study quality.

Results Seven studies were finally included in the meta-analysis (1 cross sectional and 6 casecontrol), with a total of 602 individuals (362 patients with NAFLD). Epicardial fat thickness were statistically significantly higher in patients with NAFLD than in controls (mean difference [MD] 1.17, 95% confidence interval [CI] 0.45-1.89, I2=89%). Global longitudinal strain was lower in NAFLD, to a statistically significant degree (MD -3.17, 95%CI -5.09 to -1.24, I2=89%). However, significant heterogeneity of the findings was observed.

Conclusions Our findings indicate that NAFLD is related to subclinical cardiac damage. Further studies with a larger number of biopsy-proven NAFLD patients are needed to confirm this finding. Preventive and therapeutic interventions early in the course of the disease might decrease morbidity in this high-risk patient group.

Keywords Nonalcoholic fatty liver disease, epicardial fat thickness, global longitudinal strain, liver biopsy

Ann Gastroenterol 2021; 34 (3): 424-430

Original Articles