Predictors of metabolic heart failure with preserved ejection fraction in patients with nonalcoholic fatty liver disease

Introduction

Nonalcoholic fatty liver disease (NAFLD) and Heart Failure with preserved ejection fraction (HFpEF) share similar risk factors. Patients with NAFLD are at a higher risk of developing heart failure, particularly HFpEF, compared to those without NAFLD.

We aimed to identify the risk factors for HFpEF in NAFLD and tried to establish a prediction model to evaluate the risk.

Methods

A total of 94 patients with Fatty Liver Index (FLI) ≥60 were included in the study and divided into two groups based on echocardiographic findings and NT pro BNP levels: group of patients who suffered from HFpEF (n=51) and group without Heart Failure (n=43).

Anthropometric measurements included body mass index (BMI) and waist circumference.

Cardiometabolic risk factors were analyzed: obesity, insulin resistance, diabetes, hypertension.

Insulin resistance was assessed with the use of the homeostasis model assessment (HOMA2-IR).

Laboratory evaluation included glycemia, uric acid, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), liver enzymes (AST/ALT, GGT), albumin, blood count, iron, ferritin, eGFR.

Results

Patients with HFpEF were older (75 ± 6.0 vs 59 ± 7.7, p= 0.0001), more often women (40(78.4%) vs 11 (21.6%), with significantly higher values of uric acid (342.2±91.7 vs 317.3±90.6;p=0,00006), HOMA2-IR (2.77±0.88 vs 2.59±0.70;p=0,002), lower HDL-C (1.11±0.28 vs 1,16±0.43;p=0,046), and eGFR (53.5±27.9 51.2±23.8, p= 0.18).

Patients in HFpEF group more often suffered from Hypertension (22 (43.8%) vs 15 (34.9%); p=0.004) and anemia (14 (28%) vs 2 (4,7%).

HFpEF in NAFLD associated with older age (0.960(0.937-0.984); p=0,001), female gender (1.7161(1.269-2.163); p=0,00001), higher values of uric acid (0.997(0.996-0.999); p=0,0001), and anemia (1.833(1.702-1.964); p=0,00001). Risk for HFpEF was higher in patients over 65 (AUC 0.841, p=0.0002), determined at a sensitivity and specificity of 75%.

Conclusion

Metabolic Syndrome, or Obesity, Type 2 Diabetes, Hypertension, and Dyslipidemia are primary drivers for both conditions, while anemia, higher values of uric acid and insulin resistance are a key mechanism linking NAFLD to cardiac dysfunction.

Screening for HFpEF is recommended in patients with NAFLD, especially in female patients and patients older than 65 years.