Cardiovascular Journal of Africa: Vol 26 No 3 (May/June 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015 AFRICA 109
Right ventricular function and its relationship with grade
of hepatosteatosis in non-alcoholic fatty liver disease
Adem Bekler, Emine Gazi, Gokhan Erbag, Emine Binnetoglu, Ahmet Barutcu, Hacer Sen, Ahmet Temiz,
Burak Altun
Abstract
Objective: This study was designed to assess right ventricular
systolic and diastolic function and its relationship with grade
of hepatosteatosis (HS) in non-alcoholic fatty liver disease
(NAFLD) patients using conventional and tissue Doppler
echocardiography.
Methods: NAFLD was diagnosed in 32 individuals (15
males, 17 females; 59% were grade I HS, 41% grade II–III
HS) by means of ultrasonography. Twenty-two individuals,
whose ultrasonography data did not show HS, comprised the
control group (11 males, 11 females) and were included in the
study. Right ventricular systolic and diastolic function and
their relationship with grade of HS were assessed by conven-
tional and tissue Doppler echocardiography. Additionally,
right ventricular global function was assessed by myocardial
performance index (MPI).
Results: When compared by conventional echocardiographic
parameters, there were no significant differences between the
two groups. With tissue Doppler parameters, the tricuspid
annulus peak early diastolic velocity and ratio of early-to-
late diastolic velocity were lower in the patients than in the
controls (p = 0.03, p = 0.02, respectively). The isovolumetric
relaxation time and MPI were significantly higher (p < 0.001,
p < 0.001, respectively) in the patient group. HS grade was
positively correlated with right ventricular isovolumetric
relaxation time and MPI index (r = 0.295, p = 0.03, r = 0.641,
p < 0.001, respectively).
Conclusion: These results show that right ventricular diastolic
dysfunction (RVDD) in patients with NAFLD and degree of
HS was associated with RVDD.
Keywords: echocardiography, hepatosteatosis, right ventricular
dysfunction
Submitted 21/1/13, accepted 27/11/14
Cardiovasc J Afr 2015; 26: 109–113
DOI: 10.5830/CVJA-2014-068
Non-alcoholic fatty liver disease (NAFLD) is increasingly
recognised as the most common cause of chronic liver disease
worldwide.1 NAFLD encompasses a spectrum of disorders,
including variable degrees of simple hepatic steatosis (HS, fatty
liver), non-alcoholic steatohepatitis (NASH) and cirrhosis.
This disease is a common clinicopathological condition
characterised by significant lipid deposition in the hepatocytes
of the liver parenchyma in the absence of alcohol abuse,
contributing medications and viral hepatitis. It is strongly
associated with several cardiovascular risk factors such as
obesity, insulin resistance, hypertension, hyperlipidaemia,
coronary artery disease, obstructive sleep apnoea syndrome,
oxidative stress, endothelial dysfunction and the metabolic
syndrome.2-5 There are recent data suggesting that NAFLD is
linked to increased cardiovascular risk independent from the
broad spectrum of metabolic syndrome (MS) risk factors.6,7
Multiple mechanisms contribute to left ventricular
dysfunction in obesity, including lipotoxicity associated with
cardiac steatosis and lipo-apoptosis, alterations in fatty acid
metabolism, overproduction of cardio-inhibitory cytokines,
up-regulation of some neurohormones (especially angiotensin
II), myocardial fibrosis and chronic overload with left ventricular
dilatation and hypertrophy, and increased oxygen consumption.8
Evaluating the possible influence and correlation of metabolic,
cardiovascular and liver biopsy parameters on cardiac left
ventricular dysfunction, we found a positive correlation between
left ventricular parameters and severity of liver damage (NAS
score).9 Cardiac dysfunction determined by echocardiographic
measurements in patients with NAFLD was also studied. 10
Determination of myocardial velocity using tissue Doppler
imaging (TDI) is a new technique that has recently been
developed to analyse right ventricular function.11-14
This study aimed to investigate the association between right
ventricular function and grade of hepatosteatosis (HS grade)
in NAFLD patients using transthoracic and tissue Doppler
echocardiography.
Methods
Thirty-two patients, who were admitted to the Internal Medicine
Clinic at our institution between 2011 and 2012 and were
diagnosed with hepatosteatosis using abdominal ultrasonography
(USG), performed for any reason, were included in the study,
taking into account the exclusion criteria. Twenty-two persons
were also included in the study as a control group. To eradicate
the effects of other variables on the impact of NAFLD on right
ventricular function, the control group was selected according to
the demographic and laboratory characteristics of the patients
with NAFLD. Each participant signed an informed consent form
in accordance with the Declaration of Helsinki, and this study
was approved by the local ethics committee of our hospital.
Department of Internal Medicine, Canakkale Onsekiz Mart
University, Çanakkale, Turkey
Adem Bekler, MD,
Emıne Gazi, MD
Gokhan Erbag, MD
Emine Binnetoglu, MD
Ahmet Barutcu, MD
Hacer Sen, MD
Ahmet Temiz, MD
Burak Altun, MD