Association of non-alcoholic fatty liver disease with cardiac structural impairment

Summary: Non-alcoholic fatty liver disease encompasses a spectrum of pathologic entities ranging from liver steatosis through non-alcoholic steatohepatitis and fibrosis to cirrhosis of the liver. Patients with non-alcoholic fatty liver disease have a higher incidence of coronary artery disease, cardiovascular events due to atherosclerosis, both ischemic and haemorrhagic strokes, thromboembolic events, conduction system disorders, left ventricular dysfunction, and also cardiovascular mortality. Non-alcoholic fatty liver disease is also associated with structural abnormalities of the myocardium and valves. Non-alcoholic steatohepatitis develops in about 8–20% of obese patients with simple hepatic steatosis. The disease tends to progress and may be poorly controlled therapeutically. Non-alcoholic steatohepatitis increases the risk of mortality from cardiovascular disease by 2.1-fold and the risk of mortality from any cause by 2.3-fold. The inflammatory process in the liver may represent a major determinant of systemic complications in people with non-alcoholic fatty liver disease, so its assessment could be useful for cardiovascular risk assessment. Due to the documented association between the severity of hepatic steatosis assessed by ultrasonography and coronary or carotid atherosclerosis, ultrasonographic examination of the liver may be helpful in identifying people at high cardiovascular risk. The present case report confirms the importance of echocardiographic screening for structural and functional cardiac abnormalities in patients with chronic non-alcoholic steatohepatitis in order to initiate early treatment and improve their prognosis. Key words: non-alcoholic fatty liver disease – ultrasonography – echocardiography – screening