Prevalence and Prognostic Value of Non-Alcoholic Fatty Liver Disease in Patients Hospitalized With Decompensated Chronic Heart Failure

Aim    To study the incidence and effect of non-alcoholic fatty liver disease (NAFLD) on clinical outcomes in patients with decompensated chronic heart failure (DCHF).
Material and methods    The study included 338 patients with NYHA functional class III-IV DCHF (51.2% men, mean age 72.8±11.7 years), arterial hypertension (AH) in 90%, myocardial infarction in 37%, atrial fibrillation in 64%, chronic kidney disease (CKD) in 42%, type 2 diabetes mellitus (T2DM) in 35%, left ventricular ejection fraction (LVEF) <40% in 27%. NAFLD was diagnosed based on the 2021 Clinical Guidelines of the Russian Scientific Medical Society of Therapists and the Scientific Society of Gastroenterologists of Russia. The stage of liver steatosis was determined using transient elastometry with assessment of the controlled attenuation parameter (CAP) of ultrasound (S, dB/m) using a FibroScan device. Threshold CAP values <294 dB/m corresponded to the degree of steatosis: S0; S1, 295-309 dB/m; S2, 310-330 dB/m; S3, ≥331 dB/m.
Results    NAFLD was diagnosed in 28.9% of patients. The patients were divided into two groups: group 1 included patients with CHF and NAFLD (n=98 (28.9%), 50.0% men) and group 2 included patients with CHF without NAFLD (n=240 (71.0 %), 51.6% men). A multivariate regression analysis showed that independent predictors of NAFLD were systolic blood pressure ≥130 mm Hg (odds ratio (OR), 3.700; p <0.001), history of T2DM (OR, 2.807; p <0.005), and waist circumference >111 cm (OR, 2.530; p <0.012). Patients with CAP ≥331 dB/m (S3) had a worse prognosis during the 2-year follow-up for the composite adverse outcome (all-cause mortality + readmission) (Kaplan-Meier curves - Log-Rank p=0.035).
Conclusions    NAFLD was detected in almost one-third of patients hospitalized for DCHF. AH, T2DM, and abdominal obesity were associated with a high risk of NAFLD. However, only severe steatosis (S3) was an independent predictor of adverse clinical outcomes during a 2-year period after adjustment for known risk factors.

1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. Journal of Hepatology. 2019;70(1):151–71. DOI: 10.1016/j.jhep.2018.09.014

2. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Cardiac Failure Review. 2017;3(1):7–11. DOI: 10.15420/cfr.2016:25:2

3. Jichitu A, Bungau S, Stanescu AMA, Vesa CM, Toma MM, Bustea C et al. Non-Alcoholic Fatty Liver Disease and Cardiovascular Comorbidities: Pathophysiological Links, Diagnosis, and Therapeutic Mana gement. Diagnostics. 2021;11(4):689. DOI: 10.3390/diagnostics11040689

4. Lazebnik L.B., Golovanova E.V., Turkina S.V., Raikhelson K.L., Okovityi S.V., Drapkina O.M. et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;185(1):4–52. DOI: 10.31146/1682–8658-ecg-185-1-4-52

5. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. DOI: 10.1002/hep.28431

6. Correale M, Tricarico L, Leopizzi A, Mallardi A, Mazzeo P, Tucci S et al. Liver disease and heart failure. Panminerva Medica. 2020;62(1):26–37. DOI: 10.23736/S0031-0808.19.03768-6

7. Maevskaya M.V., Kotovskaya Yu.V., Ivashkin V.T., Tkacheva O.N., Troshina E.A., Shestakova M.V. et al. The National Consensus statement on the management of adult patients with non-alco holic fatty liver disease and main comorbidities. Therapeutic Archive. 2022;94(2):216–53. DOI: 10.26442/00403660.2022.02.201363

8. Zhang Z, Wang P, Guo F, Liu X, Luo T, Guan Y et al. Chronic heart failure in patients with nonalcoholic fatty liver disease: prevalence, clinical features, and relevance. Journal of International Medical Research. 2018;46(9):3959–69. DOI: 10.1177/0300060518782780

9. Minhas AMK, Jain V, Maqsood MH, Pandey A, Khan SS, Fudim M et al. Non-Alcoholic Fatty Liver Disease, Heart Failure, and Long-Term Mortality: Insights From the National Health and Nutrition Examination Survey. Current Problems in Cardiology. 2022;47(12):101333. DOI: 10.1016/j.cpcardiol.2022.101333

10. Minhas AMK, Bhopalwala HM, Dewaswala N, Salah HM, Khan MS, Shahid I et al. Association of Non-Alcoholic Fatty Liver Disease With in-Hospital Outcomes in Primary Heart Failure Hospitalizations With Reduced or Preserved Ejection Fraction. Current Problems in Cardiology. 2023;48(8):101199. DOI: 10.1016/j.cpcardiol.2022.101199

11. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–158. DOI: 10.18087/cardio.2475

12. Petroff D, Blank V, Newsome PN, Shalimar, Voican CS, Thiele M et al. Assessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis. The Lancet Gastroenterology & Hepatology. 2021;6(3):185–98. DOI: 10.1016/S2468-1253(20)30357-5

13. Valbusa F, Bonapace S, Agnoletti D, Scala L, Grillo C, Arduini P et al. Non-alcoholic fatty liver disease and increased risk of 1-year all-cause and cardiac hospital readmissions in elderly patients admitted for acute heart failure. PLOS ONE. 2017;12(3):e0173398. DOI: 10.1371/journal.pone.0173398

14. Valbusa F, Agnoletti D, Scala L, Grillo C, Arduini P, Bonapace S et al. Non-alcoholic fatty liver disease and increased risk of all-cause mortality in elderly patients admitted for acute heart failure. International Journal of Cardiology. 2018;265:162–8. DOI: 10.1016/j.ijcard.2018.04.129

15.