title: Echocardiography and NAFLD (non-alcoholic fatty liver disease).
abstract: Non-alcoholic-fatty-liver-disease (NAFLD) is associated with atherosclerosis, increased cardiovascular risks and mortality. We investigated if, independently of insulin resistance, diet, physical activity and obesity, fatty liver involvement has any relationship with echocardiographic measurements in NAFLD.
  
  
  METHODS
  660 NAFLD and 791 non-NAFLD subjects, referred to the same out-patients medical unit for lifestyle-nutritional prescription, were studied. Congestive heart failure, myocardial infarction, malignancies, diabetes mellitus, extreme obesity, underweight-bad-nourished subjects and renal insufficiency were exclusion criteria. Liver steatosis was assessed by Ultrasound-Bright-Liver-Score (BLS), left ventricular ejection fraction (LVEF), trans-mitral E/A doppler ratio (diastolic relaxation) and left ventricular myocardial mass (LVMM/m(2)) by echocardiography. Doppler Renal artery Resistive Index (RRI), insulin resistance (HOMA) and lifestyle profile were also included in the clinical assessment.
  
  
  RESULTS
  LVMM/m(2) is significantly greater in NAFLD, 101.62±34.48 vs. 88.22±25.61, p<0.0001 both in men and in women. Ejection fraction is slightly smaller only in men with NAFLD; no significant difference was observed for the E/A ratio. BMI (30.42±5.49 vs. 24.87±3.81; p<0.0001) and HOMA (2.90±1.70 vs. 1.85±1.25; p: 0.0001) were significantly greater in NAFLD patients. By Multiple-Linear-Regression, NAFLD and unhealthy dietary profile are associated also in lean non-diabetic subjects with lower systolic function, independently of BMI, dietary profile, physical activity, RRI and insulin resistance.
  
  
  CONCLUSIONS
  NAFLD may be a meaningful early clue suggestive of diminishing heart function, with similar determining factors. NAFLD is amenable to management and improvement by lifestyle change counseling, addressing a dual target: reducing fatty liver, which is easily monitored by ultrasound, and, independently, maintaining a normal heart function.
authors.affiliation: University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Trovato
authors.affiliation: University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy.
authors.forename: Giuseppe F
authors.initials: GF
authors.lastname: Martines
authors.affiliation: University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Catalano
authors.affiliation: University of Catania, School of Medicine, Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology section, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Pirri
authors.affiliation: University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy. Electronic address: guglielmotrovato@unict.it.
authors.forename: Guglielmo M
authors.initials: GM
authors.lastname: Trovato
mesh_terms: D000328:Adult; D038441:Diet, Mediterranean; D015150:Echocardiography, Doppler / Q000379:methods; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D040242:Risk Reduction Behavior
keywords: Diastolic function; Echocardiography; Liver steatosis; Mediterranean diet; Physical activity; Systolic function