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Relationship of Nonalcoholic Fatty Liver Disease and Heart Failure With Preserved Ejection Fraction

Husam M Salah1, Ambarish Pandey2, Anzhela Soloveva3

  • 1Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

JACC. Basic to Translational Science
|December 6, 2021
PubMed

Insights

Heart failure with preserved ejection fraction (HFpEF) and nonalcoholic fatty liver disease (NAFLD) are linked. This review proposes distinct NAFLD-related HFpEF phenotypes and discusses diagnosis and treatment for this understudied association.

Area of Science:

  • Cardiology
  • Hepatology
  • Internal Medicine

Background:

  • Established bidirectional link between reduced ejection fraction heart failure and liver disease.
  • Limited exploration of the association between heart failure with preserved ejection fraction (HFpEF) and liver diseases like nonalcoholic fatty liver disease (NAFLD).

Purpose of the Study:

  • To review the relationship between HFpEF and NAFLD.
  • To propose novel NAFLD-related HFpEF phenotypes.
  • To discuss diagnostic challenges and treatment strategies for concurrent NAFLD and HFpEF.

Main Methods:

  • In-depth literature review.
  • Phenotypic classification of NAFLD-related HFpEF.
  • Discussion of diagnostic and therapeutic considerations.

Main Results:

  • Identification of three proposed NAFLD-related HFpEF phenotypes: obstructive HFpEF, metabolic HFpEF, and advanced liver fibrosis HFpEF.
  • Highlighting diagnostic complexities in patients with co-existing NAFLD and HFpEF.
  • Outlining potential treatment avenues for these specific phenotypes.

Conclusions:

  • NAFLD-related HFpEF represents a significant, under-explored clinical entity.
  • Recognition of distinct NAFLD-related HFpEF phenotypes is crucial for targeted management.
  • Further research is warranted to elucidate the pathophysiology and optimize treatment of NAFLD-related HFpEF.

Keywords:
ALT, alanine aminotransferaseAST, aspartate aminotransferaseAV, arteriovenousBCAA, branched-chain amino acidGLP, glucagon-like peptideHF, heart failureHFpEFHFpEF, heart failure with preserved ejection fractionHFrEF, heart failure with reduced ejection fractionIL, interleukinLV, left ventricularLVEF, left ventricular ejection fractionNAFLDNAFLD, nonalcoholic fatty liver diseaseNASH, nonalcoholic steatohepatitisNT-proBNP, N terminal pro–B-type natriuretic peptideRAAS, renin-angiotensin aldosterone systemSGLT2, sodium-glucose cotransporter 2SPSS, spontaneous portosystemic shunt(s)TNF, tumor necrosis factorcardiomyopathyheart failureliver

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