The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction in Patients With Nonalcoholic Fatty Liver Disease
Packer M1. Am J Med. 2019 Oct 14. pii: S0002-9343(19)30843-5. doi: 10.1016/j.amjmed.2019.09.002. [Epub ahead of print]
Author information
1 Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX and Imperial College, London, UK. Electronic address: milton.packer@baylorhealth.edu.
Abstract
The most common causes of chronic liver disease in the developed world -nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) - are the hepatic manifestations of an insulin-resistant state that is linked to visceral adiposity and systemic inflammation. NAFLD and NASH lead to an expansion of epicardial adipose tissue and the release of proinflammatory adipocytokines that cause microcirculatory dysfunction and fibrosis of the adjoining myocardium, resulting in atrial fibrillation as well as heart failure with a preserved ejection fraction (HFpEF). Inflammatory changes in the left atrium lead to electroanatomical remodeling; thus, NAFLD and NASH markedly increase the risk of atrial fibrillation. Simultaneously, patients with NAFLD or NASH commonly show diastolic dysfunction or latent HFpEF. Interventions include (1) weight loss by caloric restriction, bariatric surgery or intensive exercise; and (2) drugs that ameliorate fat-mediated inflammation in both the liver and heart (e.g., statins, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and pioglitazone). Patients with NAFLD or NASH commonly have an inflammation-related atrial and ventricular myopathy, which may contribute to symptoms and long-term outcomes.