Metabolic dysfunction-associated fatty liver disease and cardiac remodeling in non-ischemic dilated cardiomyopathy

Metabolic dysfunction-associated fatty liver disease (MAFLD) represents systemic metabolic dysfunction and is significantly associated with cardiovascular disease. However, its specific impact on cardiac remodeling in non-ischemic dilated cardiomyopathy (NIDCM) remains unclear. This study aimed to investigate the impact of MAFLD and liver fibrosis on biventricular remodeling in patients with NIDCM.

We evaluated 293 NIDCM patients using comprehensive echocardiography. Liver fibrosis was assessed via the NAFLD Fibrosis Score (NFS). Associations were analyzed using multivariable linear regression and dose-response models. MAFLD was independently associated with a larger right ventricular diameter (RV; β = 3.32, P = 0.01), increased LV posterior wall thickness (β = 0.399, P = 0.037), and a lower LV mass index (LVMI; β = -22.11, P = 0.006), alongside a reduced prevalence of eccentric hypertrophy. This reduction in LVMI showed a graded pattern across MAFLD subtypes, being most pronounced in MAFLD with diabetes. Independently of MAFLD, more severe liver fibrosis (higher NFS) was associated with larger right heart dimensions (RV, right atrium, and main pulmonary artery) across all adjusted models.

MAFLD and liver fibrosis are associated with distinct cardiac remodeling phenotypes in NIDCM, notably right heart enlargement and a unique pattern of LV remodeling. These findings highlight the clinical relevance of the liver-heart axis and support routine hepatic assessment in NIDCM management.