代謝機能障害関連脂肪肝疾患における左室駆出率の肝炎および線維症との関連

Background/Objectives: Cardiovascular disease is the leading cause of mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), which includes simple steatosis (metabolic dysfunction-associated steatotic liver, MASL), metabolic dysfunction-associated steatohepatitis (MASH), and fibrosis. This study aimed to evaluate the association between left ventricular (LV) systolic function, measured by global longitudinal strain (GLS), and liver inflammation and fibrosis in obese patients with MASLD undergoing preoperative evaluation for bariatric surgery. Methods: Intraoperative liver biopsies classified patients into four groups: non-MASLD; MASL; MASH; and MASH with fibrosis. Preoperative transthoracic echocardiography (TTE) was performed, and LV GLS was assessed using automated strain analysis. Results: Ninety-two patients were included: 13 non-MASLD, 34 MASL, 21 MASH, and 24 MASH with fibrosis. Although most patients had normal LV GLS, values were significantly lower in the MASH with fibrosis group compared to the MASL and non-MASLD groups (p = 0.011). In multivariate analysis adjusted for HDL cholesterol and LV mass, LV GLS was associated with inflammation and fibrosis (OR 0.784; 95% CI 0.637-0.965; p = 0.022). Conclusions: LV GLS was significantly lower in patients with MASH and MASH with fibrosis and was associated with hepatic inflammation and fibrosis in obese individuals undergoing bariatric surgery.