Title : Early detection of subclinical myocardial dysfunction in fatty liver disease using speckle tracking echocardiography
Abstract:
Background and Objectives: Non-Alcoholic Fatty Liver Disease (NAFLD) is increasingly recognized as a systemic condition with cardiovascular implications. Patients with NAFLD may develop subclinical myocardial dysfunction long before overt cardiac disease manifests. Conventional echocardiography may fail to detect early changes. This study aimed to evaluate whether Speckle Tracking Echocardiography (STE), specifically Global Longitudinal Strain (GLS), can identify early left ventricular dysfunction in NAFLD patients with preserved ejection fraction. We hypothesized that GLS deteriorates in proportion to hepatic steatosis severity.
Methods: This was a prospective, cross-sectional study that included 100 adults: 70 patients with ultrasound-confirmed NAFLD and 30 age- and gender-matched healthy controls. Exclusion criteria were diabetes, hypertension, ischemic heart disease, or alcohol intake >20 g/day. All participants underwent clinical assessment, laboratory testing, and abdominal elastography. Two-dimensional echocardiography and STE were performed using standard apical 2-, 3-, and 4-chamber views. GLS was calculated using vendor-independent software. Diastolic parameters and left atrial strain were also recorded.
Results: Left Ventricular Ejection Fraction (LVEF) was preserved (>55%) across all subjects. However, NAFLD patients had significantly reduced GLS compared to controls (−17.9?±?1.6% vs −20.2?±?1.3%, p < 0.001). Within the NAFLD group, GLS worsened with advancing steatosis (Grade I: −18.5?±?1.4%; Grade III: −16.8?±?1.3%, p for trend < 0.001). Liver stiffness and ALT levels correlated inversely with GLS (r = −0.45, p < 0.01). Early signs of diastolic dysfunction and reduced left atrial strain were also observed among higher-grade NAFLD patients.
Discussion & Conclusion: Speckle Tracking Echocardiography reveals early myocardial strain abnormalities in patients with fatty liver disease despite preserved ejection fraction and normal conventional echocardiography. The progressive impairment of GLS with worsening hepatic steatosis underscores the metabolic-cardiac interplay in NAFLD. GLS measurement may serve as a valuable non-invasive marker to stratify cardiovascular risk in this growing patient population. Incorporating STE into routine echocardiographic assessment for NAFLD patients could allow earlier detection and intervention.
