Nonalcoholic fatty liver disease and atrial fibrillation: the main markers of this association

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.3.273664

Keywords:

atrial fibrillation, non-alcoholic fatty liver disease, fibrosis, periostin

Abstract

The prevalence of nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has increased globally in recent years. According to recent studies, NAFLD and AF affect approximately 32 % and 0.51 % of the general population, respectively.

Aim. To examine the association between NAFLD and AF by using the FibroTest-4 (FIB-4) and the NAFLD Fibrosis score (NFS) and measuring periostin levels.

Materials and methods. In this study, we enrolled 96 patients diagnosed with NAFLD and divided them in two groups, the main group – 35 patients with NAFLD + AF and the control group – 61 patients with NAFLD alone. NFS and FIB-4 indices were calculated and serum periostin level was measured.

Results. The NAFLD + AF group had higher levels of periostin (10.80 ± 1.60 ng/ml vs. 9.80 ± 1.75 ng/ml, p < 0.001) and higher NFS (-1.05 ± 1.46 vs. -2.65 ± 1.63, p < 0.001) and FIB-4 scores (1.34 ± 0.86 vs 1.07 ± 0.60, p = 0.048). Periostin has been found to be associated with the risk of NAFLD + AF with an OR of 2.079 (95 % CI: 1.418–3.048, p < 0.001). Similar results were with NFS (OR = 3.233, 95 % CI: 1.970–5.303, p < 0.001) and FIB-4 (OR = 2.498, 95 % CI: 1.109–5.627, p = 0.027). The receiver operating characteristic (ROC) analysis was performed using three variables, NFS, FIB-4 and periostin, to determine their ability to distinguish between patients with NAFLD + AF and NAFLD alone. The results have shown that the NFS had the highest area under the curve (AUC) with a value of 0.868 (95 % CI: 0.792–0.943, p < 0.001), indicating excellent discriminatory ability. FIB-4 had an AUC of 0.651 (95 % CI: 0.537–0.765, p = 0.014), while periostin had an AUC of 0.759 (95 % CI: 0.660–0.858, p < 0.001).

Conclusions. These findings have suggested a strong association between NAFLD and AF and highlighted the importance of considering AF as a potential complication in patients with NAFLD. Both the use of the FIB-4 and NFS indices and measurement of periostin levels have been proved to be effective in detecting this association.

Author Biographies

O. B. Teslenko, Ivano-Frankivsk National Medical University, Ukraine

MD, PhD-student of the Department of Therapy, Family and Emergency Medicine of Postgraduate Education

S. V. Fedorov, Ivano-Frankivsk National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Therapy, Family and Emergency Medicine of Postgraduate Education

M. V. Bielinskyi, Ivano-Frankivsk National Medical University, Ukraine

MD, PhD-student of the Department of Internal Medicine No. 2 and Nursing

N. M. Serediuk, Ivano-Frankivsk National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine No. 2 and Nursing

References

  1. Pouwels, S., Sakran, N., Graham, Y., Leal, A., Pintar, T., Yang, W., Kassir, R., Singhal, R., Mahawar, K., & Ramnarain, D. (2022). Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss. BMC endocrine disorders, 22(1), 63. https://doi.org/10.1186/s12902-022-00980-1
  2. Ahmad, M. I., Khan, M. U., Kodali, S., Shetty, A., Bell, S. M., & Victor, D. (2022). Hepatocellular Carcinoma Due to Nonalcoholic Fatty Liver Disease: Current Concepts and Future Challenges. Journal of Hepatocellular Carcinoma, 9, 477-496. https://doi.org/10.2147/JHC.S344559
  3. Brundel, B. J. J. M., Ai, X., Hills, M. T., Kuipers, M. F., Lip, G. Y. H., & Groot, N. M. S. de. (2016). Atrial fibrillation. Nature Reviews. Disease Primers, 2(1), 16017. https://doi.org/10.1038/NRDP.2016.17
  4. Riazi, K., Azhari, H., Charette, J. H., Underwood, F. E., King, J. A., Afshar, E. E., Swain, M. G., Congly, S. E., Kaplan, G. G., & Shaheen, A. A. (2022). The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. The Lancet. Gastroenterology & Hepatology, 7(9), 851-861. https://doi.org/10.1016/S2468-1253(22)00165-0
  5. Lippi, G., Sanchis-Gomar, F., & Cervellin, G. (2021). Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. International Journal of Stroke , 16(2), 217-221. https://doi.org/10.1177/1747493019897870
  6. Ismaiel, A., & Dumitraşcu, D. L. (2019). Cardiovascular Risk in Fatty Liver Disease: The Liver-Heart Axis-Literature Review. Frontiers in Medicine, 6, 202. https://doi.org/10.3389/FMED.2019.00202
  7. Gong, H., Liu, X., & Cheng, F. (2021). Relationship between non-alcoholic fatty liver disease and cardiac arrhythmia: a systematic review and meta-analysis. The Journal of International Medical Research, 49(9), 3000605211047074. https://doi.org/10.1177/03000605211047074
  8. Jia, Y., Zhong, F., Jiang, S., Guo, Q., Jin, H., Wang, F., Li, M., Wang, L., Chen, A., Zhang, F., Shao, J., & Zheng, S. (2019). Periostin in chronic liver diseases: Current research and future perspectives. Life Sciences, 226, 91-97. https://doi.org/10.1016/J.LFS.2019.04.021
  9. Marchesini, G., Day, C. P., Dufour, J. F., Canbay, A., Nobili, V., Ratziu, V., Tilg, H., Roden, M., Gastaldelli, A., Yki-Järvinen, H., Schick, F., Vettor, R., Frühbeck, G., & Mathus-Vliegen, L. (2016). EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obesity Facts, 9(2), 65. https://doi.org/10.1159/000443344
  10. Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C., Boriani, G., Castella, M., Dan, G.-A., Dilaveris, P. E., Fauchier, L., Filippatos, G., Kalman, J. M., la Meir, M., Lane, D. A., Lebeau, J.-P., Lettino, M., Lip, G. Y. H., Pinto, F. J., … Zakirov, N. U. (2021). 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 42(5), 373-498. https://doi.org/10.1093/eurheartj/ehaa612
  11. Sterling, R. K., Lissen, E., Clumeck, N., Sola, R., Correa, M. C., Montaner, J., Sulkowski, M. S., Torriani, F. J., Dieterich, D. T., Thomas, D. L., Messinger, D., & Nelson, M. (2006). Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology (Baltimore, Md.), 43(6), 1317-1325. https://doi.org/10.1002/HEP.21178
  12. Angulo, P., Hui, J. M., Marchesini, G., Bugianesi, E., George, J., Farrell, G. C., Enders, F., Saksena, S., Burt, A. D., Bida, J. P., Lindor, K., Sanderson, S. O., Lenzi, M., Adams, L. A., Kench, J., Therneau, T. M., & Day, C. P. (2007). The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology (Baltimore, Md.), 45(4), 846-854. https://doi.org/10.1002/HEP.21496
  13. Cai, X., Zheng, S., Liu, Y., Zhang, Y., Lu, J., & Huang, Y. (2020). Nonalcoholic fatty liver disease is associated with increased risk of atrial fibrillation. Liver International , 40(7), 1594-1600. https://doi.org/10.1111/LIV.14461
  14. Kang, M. K., Park, J. G., & Kim, M. C. (2020). Association between Atrial Fibrillation and Advanced Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease. Yonsei Medical Journal, 61(10), 860. https://doi.org/10.3349/YMJ.2020.61.10.860
  15. Mózes, F. E., Lee, J. A., Selvaraj, E. A., Jayaswal, A. N. A., Trauner, M., Boursier, J., Fournier, C., Staufer, K., Stauber, R. E., Bugianesi, E., Younes, R., Gaia, S., Lupșor-Platon, M., Petta, S., Shima, T., Okanoue, T., Mahadeva, S., Chan, W. K., Eddowes, P. J., … Doward, L. (2022). Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut, 71(5), 1006-1019. https://doi.org/10.1136/GUTJNL-2021-324243
  16. Wang, Z., Wang, Y., Luo, F., Zhai, Y., Li, J., Chen, Y., Li, Q., Zhu, L., Jiao, S., Liu, P., Zhou, Y., Chen, Y., Dong, J., & Sun, Y. (2022). Impact of advanced liver fibrosis on atrial fibrillation recurrence after ablation in non-alcoholic fatty liver disease patients. Frontiers in Cardiovascular Medicine, 9, 960259. https://doi.org/10.3389/fcvm.2022.960259
  17. Zhu, J. Z., Zhu, H. T., Dai, Y. N., Li, C. X., Fang, Z. Y., Zhao, D. J., Wan, X. Y., Wang, Y. M., Wang, F., Yu, C. H., & Li, Y. M. (2016). Serum periostin is a potential biomarker for non-alcoholic fatty liver disease: a case-control study. Endocrine, 51(1), 91-100. https://doi.org/10.1007/S12020-015-0735-2
  18. Fang, L., Jin, H., Li, M., Cheng, S., & Liu, N. (2022). Serum periostin as a predictor of early recurrence of atrial fibrillation after catheter ablation. Heart and Vessels, 37(12), 2059-2066. https://doi.org/10.1007/S00380-022-02115-X/METRICS
  19. Smirne, C., Mulas, V., Barbaglia, M. N., Mallela, V. R., Minisini, R., Barizzone, N., Burlone, M. E., Pirisi, M., & Grossini, E. (2020). Periostin Circulating Levels and Genetic Variants in Patients with Non-Alcoholic Fatty Liver Disease. Diagnostics, 10(12), 1003. https://doi.org/10.3390/diagnostics10121003

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Published

2023-05-31

How to Cite

1.
Teslenko OB, Fedorov SV, Bielinskyi MV, Serediuk NM. Nonalcoholic fatty liver disease and atrial fibrillation: the main markers of this association. Zaporozhye Medical Journal [Internet]. 2023May31 [cited 2026May15];25(3):198-203. Available from: https://zmj.zsmu.edu.ua/article/view/273664

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Original research