Endocrine Abstracts

Introduction: Non-alcoholic fatty liver disease (NAFLD) and Heart Failure with Preserved Ejection Fraction (HFpEF) are two syndromes with increasing clinical relevance, mainly due to the rising prevalence of metabolic syndrome. Despite sharing a common metabolic background, the association between NAFLD severity and HFpEF has not yet been well explored.

Aim: To evaluate the association of NAFLD steatosis and fibrosis scores with cardiovascular function and the risk of cardiovascular events in a cohort of individuals with stable HFpEF.

Methods: We included individuals with stable HFpEF followed in the Heart Failure (HF) Outpatient clinic at Centro Hospitalar Universitário de São João in Porto, Portugal. Patients with significant alcohol consumption were excluded. At enrolment, a comprehensive collection of clinical/imaging data and biological samples was performed. Cardiac structure and function were evaluated by echocardiography. Endothelial function and vascular properties were assessed by Reactive Hyperemia Index (RHI), measured using EndoPAT^TM2000 device, and pulse-wave velocity. We calculated the hepatic steatosis risk using Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI), and the liver fibrosis risk using NAFLD Fibrosis Score (NFS) and BARD score. We used linear regression models to analyze the associations between NAFLD scores and parameters of cardiac and vascular function. We performed a survival analysis to evaluate the association between NAFLD scores and the risk for a composite endpoint of urgent visits due to acute HF, HF hospitalization or cardiovascular death. Models were adjusted for age, sex, and type-B natriuretic peptides.

Results: Sixty-one patients were included. The mean age was 73.8±9.2 and 54% were female. Higher FLI and HSI levels were associated with higher posterior wall thickness [β=0.15 (0.03; 0.26); P=0.016; β=0.06 (0.01; 0.11); P=0.032, respectively]. Higher NFS index was associated with higher E/e’ ratio [β=0.77 (0.00; 1.55); P=0.049] and E/A ratio [β=0.44 (0.01; 0.88); P=0.044]. Increasing BARD categories were associated with higher interventricular septum thickness [β=0.56 (0.07; 1.04); P=0.025] and E/e’ ratio [β= 1.24 (0.36; 2.12); P=0.007]. A negative association was found between HSI and RHI (β=-0.04 (-0.07; -0.00); P=0.038). In the survival analysis, we found that higher HSI levels and higher BARD categories were associated with an increased risk for the combined outcome [HR=1.10 (1.04; 1.18); P=0.002; HR=2.40 (1.37; 4.20), P=0.002, respectively].

Conclusions: These results suggest that the presence of liver steatosis or fibrosis are associated with increased ventricular mass, impaired endothelial and diastolic functions, and with a higher risk for cardiovascular events, in individuals with stable HFpEF.