Liver fibrosis might drive fibrogenesis in the heart in early alcoholic liver disease

Alcohol use disorder (AUD) is associated with the development of psychiatric conditions as well as alcoholic liver disease (ALD). Ethanol toxicity but also the intestinal microbiota are important drivers of fibrogenesis in the liver and eventually also of the myocardium.

The aim of our study was the investigation of simultaneous development of fibrosis in liver and heart in patients with early ALD.

The HALFWAY-Study is a cohort study, recruiting patients with ALD during a detoxification program. Liver stiffness was measured by non-invasive elastography (ARFI, Acoustic Radiation Force Impulse). Echocardiographic measured E/e' (early ventricle filling velocity, E / mitral annular early diastolic velocity, e') and left atrial volume (LaVol) were used as surrogate markers for atrial filling pressure, which in case of normal de-loading of the left ventricle, correlates with diastolic dysfunction.

50 patients were included into the study (females n=27, males n=23). Participants were young (mean age 43.3 years ± 7.3), non-obese (body mass index; BMI 23.9 kg/m² ±3.9) and non-diabetic (HbA1c 5.1% ± 0.3), ruling out metabolic disease. All patients displayed normal ejection fraction (EF; 61.3% ± 9.1) a global longitudinal strain (4 chamber view) of −15.03±3.7 and NTproBNP (50 pg/ml; IQR 46.5). 95% of patients reported alcohol consumption more than four times a week, with 65% drinking 7–8 drinks per day and 25% consuming more than daily 10 drinks. The mean liver stiffness was 6.5 kPa ± 4.2, whereby in 18% of participants a significant liver fibrosis was diagnosed. We could observe a significant correlation between non-invasive liver stiffness measurements (ARFI) and E/e' (p=0.019, R=0.338) as well as LaVol (p=0.043, R=0.29). In a multivariate linear regression model using ARFI, EF, LaVol and global strain as independent variables, using the backward selection method (R2=0.114, p=0.022 for the final model), we identified ARFI as the only significant predictor of E/e' (B=0,337; p=0.022).

In patients with early ALD liver stiffness (measured by ARFI) independently predicts E/e' which might indicate simultaneous fibrogenesis of liver and heart.

Type of funding sources: Foundation. Main funding source(s): ÖGGH