Association between liver fibrosis and decreased myocardial mechano-energetic efficiency in individuals with different degree of glucose tolerance

Aim: Decreased myocardial mechano-energetic efficiency (MEEi) is associated with NAFLD and poorer prognosis in liver cirrhosis. We aim to investigate the association between liver fibrosis severity and MEEi in individuals participating in the CATAnzaro MEtabolic RIsk factors (CATAMERI) study.Methods: Myocardial MEEi, assessed by an echocardiography-derived measure, and fibrosis severity, estimated by the fibrosis-4 index (FIB-4), were evaluated in 2383 subjects with different degree of glucose tolerance. Participants were divided into four groups according to FIB-4 index values: lowest risk of fibrosis (<1.3); low risk of fibrosis (>= 1.3 to < 1.67); moderate risk of fibrosis (>= 1.67 to < 2.67); high risk of fibrosis (>= 2.67).Results: Subjects with higher risk of liver fibrosis displayed a graded decrease in myocardial MEEi compare to those with the lowest risk of liver fibrosis. In a multivariable regression analysis, FIB-4 index was independently associated with MEEi (8 = -0.080, P < 0.001), along with total cholesterol (8 = -0.067, P = 0.01), hsCRP (8 = -0.081, P < 0.001), sex (8 = -0.099, P < 0.001), glucose tolerance status (8 = -0.109, <0.001) and HOMA-IR index (8 = -0.143, P < 0.001).Conclusion: Compromised myocardial MEEi is already reported in individuals with high risk of hepatic fibrosis suggesting that its assessment may help to identify among subjects with NAFLD those with worst prognosis.