Liver stiffness measurement identifies subclinical myocardial dysfunction in non‑advanced non‑alcoholic fatty liver disease patients without overt heart disease

Patients with non-advanced non-alcoholic fatty liver disease (NAFLD) have an increased cardiovascular risk. The present 
study was designed to evaluate the relationship between liver stiffness measurement (LSM) by transient elastography (TE) 
and myocardial deformation indices of all cardiac chambers in NAFLD patients without overt heart disease. All consecutive 
NAFLD patients diagnosed with LSM < 12.5 kPa on TE between September 2021 and December 2021 entered the study. All 
participants underwent blood tests, TE and two-dimensional (2D) transthoracic echocardiography (TTE) implemented with 
speckle-tracking echocardiography (STE) analysis of left ventricular (LV) global longitudinal strain (GLS), global circum-
ferential strain (GCS) and global radial strain (GRS), right ventricular (RV) GLS, left atrial (LA) total global strain (TGSA) 
and right atrial (RA) TGSA. Main independent predictors of impaired LV-GLS (defined as absolute value less negative than 
− 20%) were evaluated. A total of 92 NAFLD patients (54.0 ± 11.1 years, 50% males) were prospectively analyzed. Mean 
LSM was 6.2 ± 2.4 kPa. Fibroscan results revealed that 76.1% of patients had F0-F1, 5.4% F2 and 18.5% F3 liver fibrosis. 
Despite normal biventricular systolic function on 2D-TTE, LV-GLS, LV-GCS and LV-GRS, RV-GLS, LA-TGSA and RA-
TGSA were reduced in 64.1%, 38.0%, 38.0%, 31.5%, 39.1% and 41.3% of patients, respectively. Body mass index (BMI) (OR 
1.76, 95% CI 1.18–2.64), neutrophil-to-lymphocyte ratio (NLR) (OR 4.93, 95% CI 1.15–31.8) and LSM (OR 9.26, 95% CI 
2.24–38.3) were independently associated to impaired LV-GLS. BMI ≥ 29.3 kg/m2, NLR ≥ 1.8 and LSM ≥ 5.5 kPa were the 
best cut-off values for detecting outcome. LSM ≥ 5.5 kPa identifies NAFLD patients with subclinical myocardial dysfunction.