title: Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: association with the severity of liver disease.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) has been associated with increased cardiovascular risk, including coronary artery disease and cardiac dysfunction. In addition, recent evidence highlighted the possible role of epicardial fat as a new cardiometabolic risk factor. We tested the correlation between epicardial fat, alterations in cardiac geometry and function, and severity of liver damage, in patients with biopsy-proven NAFLD.
  
  
  METHODS
  The anthropometric, biochemical and metabolic features were recorded in 147 consecutive biopsy-proven NAFLD cases (Kleiner score). Epicardial fat thickness was measured by echocardiography.
  
  
  RESULTS
  Epicardial fat was higher in patients with severe vs. milder fibrosis (8.5 ± 3.0 vs. 7.2 ± 2.3 mm; p=0.006); this association was maintained at multivariate logistic regression analysis (OR 1.22, 95%C.I. 1.01-1.47; p=0.04) after correction for gender, age >50 years, visceral obesity, IFG/diabetes, non-alcoholic steatohepatitis and severe steatosis. Of note, 37.1% of patients with epicardial fat >7 mm (median value) had severe liver fibrosis, compared to 18.3% of the cases with lower epicardial fat (p=0.01). As for echocardiographic indices, after adjusting for cardiometabolic confounders, diastolic posterior-wall thickness (p=0.01), left ventricular mass (p=0.03), relative wall thickness (p=0.02), and left atrial volume (0.04), as well as ejection fraction (p=0.004), lower lateral TDI e' (p=0.009), E/A ratio (0.04) (cardiac geometry alterations and diastolic dysfunction) were linked to severe liver fibrosis.
  
  
  CONCLUSIONS
  In patients with NAFLD, a higher epicardial fat thickness is associated with the severity of liver fibrosis, in keeping with a possible pathogenic role of ectopic fat depots in whole body organ damage. In addition, morphological and functional cardiac alterations are more pronounced according to the severity of fibrosis. Further studies are needed to validate our results.
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy. Electronic address: salvatore.petta@unipa.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.
authors.forename: Christiano
authors.initials: C
authors.lastname: Argano
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Colomba
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.affiliation: Cattedra di Anatomia Patologica, University of Palermo, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cabibi
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche, "Alma Mater Studiorum", Università di Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Università di Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Licata
authors.affiliation: Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D010496:Pericardium / Q000000981:diagnostic imaging*; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic
keywords: Cardiac dysfunction; Epicardial fat; NAFLD; NASH