The association between non-invasive tests of liver fibrosis and early diastolic dysfunction in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) may contribute to cardiac impairment through diastolic dysfunction. Non-invasive tests (NITs) for liver fibrosis offer valuable tools for risk stratification, though their utility in identifying patients with early or established diastolic dysfunction remains uncertain. Identify the association between liver NITs (FIB-4 and liver stiffness measurement [LSM]) and echocardiographic markers of diastolic dysfunction. We prospectively enrolled 150 MASLD patients without cardiovascular disease history. All patients underwent clinical-biochemical evaluation, vibration-controlled transient elastography for LSM, echocardiography with speckle tracking analysis. Significant fibrosis was defined by FIB-4 >1.3 or LSM ≥7 kPa. Diastolic dysfunction was defined by mitral E/E' ratio >9, while early diastolic dysfunction was defined by left atrial strain reservoir (LARS) (<22%) and left atrial stiffness index (LASi) ≥25 kPa. Pericardial fat was also assessed. Increased FIB-4 was found in 23,3% patients (median age 62) with prevalence of type 2 diabetes (T2DM), hypertension and dyslipidemia respectively at 20%, 74,3%, 62,9%. For low FIB-4 group (median age 49), prevalences were 15%, 36,5%, 55,7%. Obesity overall was 43,9%. Compared to patients with low FIB-4, those with FIB-4 >1.3 had increased E/E' ratio, LASI and pericardial fat (respectively median 8.0 [6,0 – 9,2], p =0.007; 0.34 kPa [0,20 - 0,42], p <0.0001; 12.5 mm [8,5 – 17,2], p <0.0001), and had reduced LARS (26.5% [19,0 – 33,0], p <0.0001). In a 3 model multivariable regression analysis, FIB-4 >1.3 was independently associated with diastolic dysfunction (aOR 3.41 [1.08 – 10.74]) and early diastolic dysfunction (aOR for reduced LARS 10.03 [2.01 – 49.8]; aOR for reduced LASi 4.24 [1.16 – 15.5]). Finally, FIB-4 displayed Area Under the Curve (AUC) of 0.83 for the prediction of reduced LARS. In MASLD patients without cardiac disease, FIB-4 may be useful to identify a higher risk with early cardiac dysfunction, suggesting tailored echocardiography surveillance [ABSTRACT FROM AUTHOR]