title: Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular (LV) function, yet the impact of NAFLD on right ventricular (RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD.
  
  
  METHODS
  Ninety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE).
  
  
  RESULTS
  Mean fibrosis stage and nonalcoholic steatohepatitis (NASH) scores were 1.3 ± 1.1 and 5.2 ± 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 ± 3.4% vs. 21.6 ± 2.3%, P < 0.001). NASH score ≥5 was associated with lower RV-GLS (18.9 ± 3.1% vs. 21.0 ± 3.4%, P = 0.006). NASH score inversely correlated with RV-GLS (r = -0.370, P < 0.001) such as patients with impaired RV-GLS (<19%) showed significantly higher NASH score compared to normal RV-GLS group (5.8 ± 1.4 vs. 4.8 ± 1.7, P = 0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD.
  
  
  CONCLUSIONS
  Patients with NAFLD have impaired RV function. NASH score inversely correlates with RV-GLS and independently predicts impaired RV function in patients with NAFLD.
authors.affiliation: Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sunbul
authors.affiliation: Cardiology Clinic, Sivas Numune Hospital, Sivas, Turkey.
authors.forename: Tarik
authors.initials: T
authors.lastname: Kivrak
authors.affiliation: Cardiology Clinic, Silifke State Hospital, Mersin, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Durmus
authors.affiliation: Department of Gastroenterology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akin
authors.affiliation: Department of Gastroenterology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Yucel
authors.initials: Y
authors.lastname: Aydin
authors.affiliation: Department of Radiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Rabia
authors.initials: R
authors.lastname: Ergelen
authors.affiliation: Department of Gastroenterology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yilmaz
authors.affiliation: Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Agirbasli
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D004452:Echocardiography; D005260:Female; D005355:Fibrosis; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D012044:Regression Analysis; D018497:Ventricular Dysfunction, Right / Q000150:complications*
keywords: Right ventricular function; nonalcoholic fatty liver disease; speckle-tracking echocardiography