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Cardiac remodelling in novel cluster-based metabolic (dysfunction)-associated fatty liver disease: a cross-sectional
Yina Wang1, Xiaolan Ouyang2, Na Ye3
1VIP Medical Service Center, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Objectives:
To identify novel, data-driven phenotypic clusters of metabolic dysfunction-associated fatty liver disease (MAFLD) and investigate their associations with cardiac remodelling.
Design:
Cross-sectional study.
Setting:
Secondary care; a single-centre study in China.
Participants:
A total of 3233 participants diagnosed with MAFLD were included in the study. The diagnosis was conducted in accordance with the established criteria for MAFLD. The exclusion criteria encompassed a history of significant cardiovascular or hepatic diseases, as well as excessive alcohol consumption.
Primary Outcome Measures:
Echocardiographic parameters of cardiac structure and function.
Results:
Four distinct clusters were identified. Cluster 1 (n=1381) comprised men with a normal metabolic state and low Fibrosis-4 Index (FIB-4) levels. Cluster 2 (n=453) included men with the highest body mass index (BMI) and uric acid levels. Cluster 3 (n=474) consisted of men with the most severe glucose and lipid metabolic disturbances. Cluster 4 (n=925) comprised women with the highest FIB-4 levels. Compared with Cluster 1, participants in Clusters 2 and 3 exhibited worse cardiac structure and function, including enlargement of the left atrium (LA), right atrium, left ventricular internal end-diastolic dimension, interventricular septum (IVS), left ventricular posterior wall (LVPW) thickness, right ventricular and reduced left ventricular ejection fraction. Conversely, participants in Cluster 4 had better cardiac structure and function compared with those in Cluster 1. After adjusting for confounders, Cluster 2 showed positive associations with the LA, IVS, LVPW, right atrium and right ventricular (all p<0.001), while Cluster 4 showed negative associations.
Conclusions:
The heterogeneity of MAFLD reveals sex-specific patterns of cardiac remodelling: male phenotypes with high BMI and uric acid levels are associated with worse remodelling, whereas a female phenotype characterised by high FIB-4 levels correlates with preserved cardiac function.
