Moderate/advanced MASLD patients had increased LV mass index (70.3 vs 65.6 g/m²), higher E/e' ratio (7.80 vs 7.00), and more cardiovascular comorbidities.
Does moderate/advanced liver fibrosis associate with adverse cardiac remodeling and worse function compared to mild fibrosis in patients with MASLD?
In patients with MASLD, increased liver fibrosis severity is associated with adverse cardiac remodeling, higher filling pressures, and a greater burden of cardiovascular comorbidities.
Abstract Background Metabolic-Associated Steatotic Liver Disease (MASLD) is a growing public health concern linked to metabolic syndrome and cardiovascular disease. Although the Fibrosis-4 (FIB-4) Index for Liver Fibrosis score predicts hepatic outcomes, the impact of liver fibrosis severity on cardiac structure and function remains underexplored. Purpose This study aimed to compare cardiac structure and function, comorbidity profiles, and key blood biomarkers between MASLD patients with mild fibrosis and those with moderate/advanced fibrosis. Methods A subset of the CoCoMASLD study with available FIB-4 scores were analyzed and stratified into mild fibrosis (FIB-4 1.3) and moderate/advanced fibrosis (FIB-4 ≥ 1.3). Participants underwent comprehensive echocardiographic evaluation, detailed clinical assessment, and laboratory testing. Cardiac parameters, including left ventricular (LV) chamber dimensions, LV mass, left atrial (LA) volumes, and diastolic indices, were compared between groups. Comorbidities and blood samples were similarly evaluated. Results A total of 428 patients with FIB-4 scores were included (Mild, N = 233 (54.4%); Moderate/Advanced, N = 195 (45.6%)). Patients with moderate/advanced MASLD were significantly older than those with mild disease (63.4 ± 8.7 vs. 55.5 ± 10.9 years, p0.001). Echocardiography revealed evidence of increased interventricular septal thickness (0.97 vs. 0.89 cm, p=0.003), LV posterior wall thickness (0.93 vs. 0.89 cm, p=0.02), and greater LV mass index (70.3 vs. 65.6 g/m², p=0.003) in the moderate/advanced group. LA volume index was also higher (25.4 vs. 23.1 mL/m², p0.001). Moderate/advanced MASLD had higher filling pressures reflected by higher E/e′ ratios (7.80 vs. 7.00, p0.001). Additionally, a higher aortic pressure gradient (7.00 vs. 6.00 mmHg, p=0.03) and increased tricuspid annular systolic velocity (15.2 vs. 14.4 cm/s, p=0.02) were observed in the moderate/advanced group. Patients with moderate/advanced MASLD also had a higher prevalence of cardiovascular comorbidities. Notably, diabetes (39.5% vs. 27.5%, p=0.01), hypertension (51.8% vs. 41.6%, p=0.04), and ischemic heart disease (8.7% vs. 2.1%, p=0.004) were more common. Laboratory analyses demonstrated higher AST (32.0 vs. 25.5 U/L, p0.001) and bilirubin levels (10.0 vs. 8.0 μmol/L, p0.001) in patients with more advanced fibrosis, as well as significantly lower LDL-cholesterol levels (2.45 vs. 2.69 mmol/L, p=0.01). Conclusion In this cohort of MASLD patients with available FIB-4 scores, increased liver fibrosis severity was associated with adverse cardiac remodeling and higher filling pressures, as well as a higher prevalence of cardiovascular comorbidities and distinct laboratory abnormalities. These findings underscore the importance of integrated cardiovascular and hepatic evaluation in MASLD, particularly in patients with advanced fibrosis.Cardiac structure by MASLD fibrosis
Davidovski et al. (2025) studied this question. Moderate/advanced MASLD patients had increased LV mass index (70.3 vs 65.6 g/m²), higher E/e' ratio (7.80 vs 7.00), and more cardiovascular comorbidities.