Metabolic dysfunction-associated fatty liver disease and its clinical implications in heart failure

Heart-liver metabolic crosstalk contributes to heart failure pathophysiology. Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new disease entity based on positive metabolic criteria. However, the clinical implications of MAFLD in heart failure remain to be fully elucidated.

We enrolled 457 hospitalized patients with symptomatic stage C/D heart failure who underwent abdominal ultrasonography for liver assessment. MAFLD was diagnosed based on the presence of hepatic steatosis and metabolic dysfunction. Overall, 20.1% of patients met the criteria for MAFLD. Patients with MAFLD were younger, had higher tricuspid annular plane systolic excursion (TAPSE), and lower B-type natriuretic peptide levels compared to those without MAFLD. In multivariate logistic regression analysis, TAPSE remained independently associated with MAFLD. During a median follow-up period of 1127 days, Kaplan-Meier analysis demonstrated that patients with MAFLD showed a higher event-free survival from all-cause mortality, but not from composite cardiac events. In multivariable Cox proportional hazards analysis, MAFLD was not independently associated with all-cause mortality.

MAFLD was common among the hospitalized patients with heart failure. Although MAFLD appeared to be associated with lower overall mortality, MAFLD was not independently associated with mortality from any cause or future cardiac events.