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Review Article
Year: 2020 I Volume: 2 I Issue: 2 I Pages I 1-8

Subclinical Left Ventricular Systolic Dysfunction Assessed Using Myocardial Strain Measured by Speckle Tracking in Non-Alcoholic Fatty Liver Disease – Systematic Review

Abdulrahman Ismaiel1,2*, Nahlah Al Srouji3

1 Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

2 2nd Department of Internal Medicine, Cluj-Napoca, Romania.

3 Leon Daniello Clinical Hospital of Pneumology, Cluj-Napoca, Romania 

* Corresponding Author:

Abdulrahman Ismaiel, MD

Email address:

Source of funding:  None


Conflict of interest: None

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Background and Aims: Multiple studies demonstrated that non-alcoholic fatty liver disease (NAFLD) is associated with several structural and functional cardiovascular complications. The aim of this systematic review is to evaluate subclinical left ventricular (LV) systolic dysfunction in NAFLD assessed with myocardial strain measured by speckle tracking echocardiography (STE). Methods: We performed a systematic search on PubMed and EMBASE with predefined keywords searching for observational studies published till 19 March 2020. NAFLD diagnosis was accepted if confirmed by biopsy or imaging techniques and LV systolic function evaluation by STE. Full articles that fulfilled our inclusion and exclusion criteria were included in the systematic review. The National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools were used for evaluation of included studies. Results: Eleven observational studies (9 cross-sectional studies, 1 case-control, 1 longitudinal cohort) were included with a total study population of 5,851 subjects. All included studies evaluated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Only two studies rated as “good” demonstrated that NAFLD patients had a reduced LVEF, out of which, one study was conducted on type 2 diabetic patients, while the other study was a population-based longitudinal cohort. Moreover, eight studies, out of which four were rated “good”, two as “fair” and two as “poor” demonstrated that GLS was significantly reduced in NAFLD. On the other hand, the remaining three studies that reported a non-significant difference in GLS were conducted on type 2 diabetic patients in two of the studies, one rated as “fair” and one as “good”. Furthermore, the third study was involving only NAFLD patients comparing drinkers with non-drinkers, being rated as “good”. Conclusions: NAFLD patients are at increased risk to develop subclinical LV systolic dysfunction assessed with myocardial strain measured by speckle tracking, despite having normal LVEF values and remaining asymptomatic. This association remains to be confirmed in more studies involving diabetic patients in the presence and absence of NAFLD.

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