Comparison of diagnostic criteria for fatty liver disease in assessing cardiac dysfunction: a cross-sectional study

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an alternative to the established definition of metabolic dysfunction-associated fatty liver disease (MAFLD). We aimed to compare the utility of using MASLD and MAFLD in identifying individuals with impaired cardiac function.

This cross-sectional study included 7,094 participants who underwent routine health examinations at Asan Medical Centre in Seoul, Republic of Korea. Abdominal ultrasonography was performed to diagnose fatty liver disease. Transthoracic echocardiography was performed to assess cardiac function.

MASLD and MAFLD were identified in 2,436 (34.3%) and 2,578 (36.3%) participants, respectively. Significantly lower E wave and E/A ratio with higher LA diameter, A wave, and E/E' ratio were observed in patients diagnosed with MASLD or MAFLD, indicating impaired diastolic function. The risk of left ventricular (LV) diastolic dysfunction is significantly higher in patients diagnosed with MAFLD only than in those diagnosed with MASLD only (24.2% vs 10.9%). Logistic regression analysis revealed, that compared with the presence of MASLD, the presence of MAFLD was independently associated with a 2.857-fold increase in the risk of LV diastolic dysfunction (95% confidence interval: 1.121-7.281, p = 0.028), even after adjusting for age, sex, and other clinical variables.

The MAFLD and MASLD criteria are associated with LV diastolic dysfunction; however, the MAFLD criteria more accurately reflect early cardiac impairment in a generally healthy population. Therefore, adopting the MAFLD criteria in clinical practice may facilitate improved cardiovascular risk stratification and early intervention.