Professor Kang Eun-seok and Lee Yong-ho

A research team at Yonsei University’s Severance Hospital has found non-alcoholic fatty liver can cause cardiac muscle weakness and increase the risk of heart failure, the hospital said Tuesday.

The study, led by Professors Kang Eun-seok and Lee Yong-ho from Severance Hospital’s endocrinology department, was aimed to investigate the effect of fatty liver on the heart in patients who underwent physical examinations at the hospital.

The researchers selected 308 patients who visited Severance Hospital. Of the total, 118 were diagnosed with nonalcoholic fatty liver (diagnosis group), while 190 maintained normal liver functions (control group). The mean body mass index (BMI) of the diagnostic group was 26±3 ㎏/㎡, which was higher than that of the control group’s 23±2.7 ㎏/㎡. The hypertension rate was also higher in the diagnosis group than in the control group (47 percent to 33 percent) as well as the diabetes ratio (24 percent to 13 percent).

Further evaluation of the patient’s positron emission tomography (PET) and echocardiography showed that there was a significant difference between the diagnostic and control groups in cardiac function. Echocardiography revealed cardiac dysfunction and structural deformation in the diagnostic group.

PET-CT also showed that the glucose uptake rate of cardiac muscle in the diagnostic group was about 30 percent lower than that of the control group, relatively decreasing the metabolic activation of the heart muscle.

The diagnose group’s cardiac output, which shows the cardiac contractile function, was similar to that of the control group, but the ratio of the patients with decreased left ventricular systolic function was 1.9 times higher. Also, the size of the left atrium in the diagnosis group was 1.2 times more massive.

“If the relaxation function is lowered due to the weakening of the heart muscle, it can lead to diastolic heart failure," Prof. Kang said. “More than half of all patients with heart failure experience diastolic heart failure with its prevalence increasing.”

Heart failure is severe heart disease, in which the heart does not adequately circulate the blood. The number of Korean patients with heart failure has increased from 89,000 to 122,000 in the past seven years, and the mortality rate has also worsened from 3.7 to 10 per 100,000, during that time.

“The deterioration of cardiac dilatation was 2.3 times higher in the diagnostic group than in the control group when the liver tissue was losing elasticity and had stiffening fibrosis,” Kang said.

The team expects that the number of Korean patients with high levels of the non-alcoholic fatty liver will increase, and if diabetes and obesity coexist, there is a high probability that the patient develops steatohepatitis, which will increase the risk of diastolic heart failure, he added.

The results of the study were published in the Journal of Hepatology, one of the most influential hepatology-related publications.

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