title: Serum alanine aminotransferase predicts interventricular septum thickness and left ventricular mass in patients with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Alanine aminotransferase (ALT) is a marker of nonalcoholic fatty liver disease (NAFLD) and predicts type 2 diabetes mellitus (DM2) as well as coronary events independently of traditional risk factors and the features of the metabolic syndrome. The extent to which interventricular septum thickness (IVS) and left ventricular mass (LVM) are associated with ALT levels in cohorts of individuals with body weights ranging from overweight to morbid obesity and NAFLD remains still unknown.
  
  
  METHODS
  This was a cross-sectional pilot study involving 151 young White participants with liver ultrasound-proven NAFLD. Standard echocardiograms were used to define LVM, IVS, and left ventricle diastolic function [mitral inflow velocity pattern (E/A ratio) and mitral annulus velocity by tissue Doppler imaging (Em/Am ratio)]. Participants were classified according to ALT quartiles: p25, p50, p75, and p100.
  
  
  RESULTS
  The study included 36 men and 115 women with an age of 38.4 ± 0.7 years and BMI of 43.9 ± 0.6 kg/m2. p100 participants disclosed significantly higher homeostasis model assessment (P=0.003), DM2 (P=0.002), and hypertension (P=0.01) prevalence, whereas LVM, IVS, E/A, and Em/Am ratios were significantly higher in this group when compared with their p25 peers (P<0.01). IVS's and LVM's variance were significantly predicted by the statistical models including ALT independently of BMI, hypertension, and DM2.
  
  
  CONCLUSIONS
  ALT levels predict both IVS and LVM in NAFLD individuals irrespective of their BMI, DM2, hypertension, age, and sex. ALT levels behave as a surrogate marker of left ventricular hypertrophy in overweight and/or obese NAFLD patients. Hence, it seems worth obtaining cardiac ultrasounds in NAFLD patients with elevated ALT levels.
authors.affiliation: aOverweight and Obesity Unit bDr Ballesta's Laparoscopic Surgical Center, Centro Médico Teknon, Barcelona, Spain cCleveland Clinic Foundation, Medina Hospital, Medina, Ohio, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Ybarra
authors.forename: Sandra
authors.initials: S
authors.lastname: Fernández
authors.forename: Joan
authors.initials: J
authors.lastname: Sánchez-Hernández
authors.forename: June H
authors.initials: JH
authors.lastname: Romeo
authors.forename: Carlos
authors.initials: C
authors.lastname: Ballesta-Lopez
authors.forename: Javier
authors.initials: J
authors.lastname: Guell
authors.forename: Fermin
authors.initials: F
authors.lastname: Mearin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D004796:Clinical Enzyme Tests / Q000379:methods; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D009765:Obesity / Q000150:complications / Q000201:enzymology; D050177:Overweight / Q000150:complications / Q000201:enzymology; D010865:Pilot Projects
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase