The value of speckle tracking echocardiography in detecting early cardiac dysfunction in non-diabetic, non-hypertensive chronic liver disease patients
Authors: Mahmoud Kamal H , Rizk J , Abdelmotelb H , Elsharkway E , Abdelety A 
Published: January 2025

Abstract

Background
Understanding the cardio-hepatic interaction in chronic liver disease (CLD) patients is essential to ensure better prognosis. Recent studies have suggested that non-alcoholic fatty liver disease (NAFLD) can be an early mediator of cardiovascular disease (CVD) independent of underlying cardiometabolic risk factors. However, whether this also applies to non-NAFLD patients has not been fully described.

Purpose
The aim of our study is to investigate the presence of myocardial remodeling and dysfunction in CLD patients of different etiologies independent of the presence of diabetes mellitus or hypertension.

Methods
Our study included 30 non-diabetic nor hypertensive CLD patients, sub-divided into two groups; group I (non-NAFLD) and group II (NAFLD). Both groups were compared to group III (25 healthy controls). Conventional echocardiographic parameters as well as left ventricular global longitudinal strain (LV GLS), right ventricular free wall strain (RV FWS) and left atrial (LA) strain were acquired.

Results
63.3 % (n=19) were females and the mean age was 53.0± 14.55 years. 40% (n= 12) of our studied patients were NAFLD patients. None of the conventional echocardiographic parameters were statistically significant between the NAFLD and the non-NAFLD group. However, the septal and the lateral e’ were significantly lower in the CLD group as compared to the controls (10.20 cm/sec ±2.78 vs 11.87 cm/sec ± 2.29, P= &lt; 0.001 for the septal e’ and 13.55 cm/sec ± 4.58 vs 17.08 cm/sec ± 3.62, P =&lt;0.001 for the lateral e’). LV GLS was also significantly lower in CLD patients than in the controls (-20.39% ± 2.95 vs -21.92% ± 2.06, P=&lt;0.001). Among CLD patients, LV GLS was lower in the NAFLD patients (-17.52% ± 2.79 vs -20.19 % ± 2.69, P= 0.013), although still within the normal range. On the other hand, there was no statistically significant difference in the RVFWS between the NAFLD and the non-NAFLD patients (-22.68 % ± 4.25 vs -24.28% ± 5.50, P=0.652), but both groups had lower values compared to the controls (-26.47 ± 5.72 vs -29.85% ± 4.61, P= 0.001). Similarly, LA reservoir and conduit strain were not statistically significant between the NAFLD and the non-NAFLD patients (37.59 % ±12.96 vs 41.02 % ±10.71, P=0.738 for LA reservoir strain and -22.83 % ±10.78 vs -23.46 % ±7.79, P=0.860 for the LA conduit strain), but they were significantly lower in the CLD patients (NAFLD and non-NAFLD) than in our control group (43.95% ±13.35 vs 49.94% ±12.54, P=0.002 and -27.23 ± 11.34% vs - 32.20 ± 11.49%, P=0.002, for LA reservoir and conduit strain respectively).

Conclusion
Speckle tracking echocardiography can detect early ventricular dysfunction and changes in left atrial mechanics in CLD patients. CLD patients show lower LV GLS, RV FWS and LA conduit and reservoir strain in comparison to healthy controls. Cardiovascular structural and functional abnormalities can be present in CLD regardless of the conventional CVD risk factors.