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Chen Z, Liu J, Zhou F, Li H, Zhang XJ, She ZG, Lu Z, Cai J, Li H. Nonalcoholic Fatty Liver Disease: An Emerging Driver of Cardiac Arrhythmia. Circ Res 2021; 128:1747-1765. [PMID: 34043417 DOI: 10.1161/circresaha.121.319059] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac arrhythmias and the resulting sudden cardiac death are significant cardiovascular complications that continue to impose a heavy burden on patients and society. An emerging body of evidence indicates that nonalcoholic fatty liver disease (NAFLD) is closely associated with the risk of cardiac arrhythmias, independent of other conventional cardiometabolic comorbidities. Although most studies focus on the relationship between NAFLD and atrial fibrillation, associations with ventricular arrhythmias and cardiac conduction defects have also been reported. Mechanistic investigations suggest that a number of NAFLD-related pathophysiological alterations may potentially elicit structural, electrical, and autonomic remodeling in the heart, contributing to arrhythmogenic substrates in the heart. NAFLD is now the most common liver and metabolic disease in the world. However, the upsurge in the prevalence of NAFLD as an emerging risk factor for cardiac arrhythmias has received little attention. In this review, we summarize the clinical evidence and putative pathophysiological mechanisms for the emerging roles of NAFLD in cardiac arrhythmias, with the purpose of highlighting the notion that NAFLD may serve as an independent risk factor and a potential driving force in the development and progression of cardiac arrhythmias.
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Affiliation(s)
- Ze Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Department of Cardiology (Z.C., Z.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Jiayi Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Feng Zhou
- Medical Science Research Center (F.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Medical Science Research Center (F.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Xiao-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Zhibing Lu
- Department of Cardiology (Z.C., Z.L.), Zhongnan Hospital of Wuhan University, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China (J.C.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China.,Basic Medical School (H.L.), Wuhan University, China
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Direct bilirubin level is an independent risk factor for atrial fibrillation in thyrotoxic patients receiving radioactive iodine therapy. Nucl Med Commun 2020; 40:1289-1294. [PMID: 31725052 DOI: 10.1097/mnm.0000000000001107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to indicate the risk factors of atrial fibrillation (AF) in thyrotoxic patients receiving radioactive iodine (RAI) therapy after antithyroid drug and other medication. METHODS This study was a retrospective cohort study. Thyrotoxic patients were divided into two groups, with or without AF. Clinical features were retrospectively analyzed. Univariate and multivariate analyses of data from thyrotoxic patients were performed to evaluate the probability of AF. RESULTS The following clinical factors were found to be correlated with AF: age, gender, duration of hyperthyroidism, coronary artery disease, hypertension, and levels of platelets, creatinine, uric acid (UA), and certain liver enzymes. According to the multiple logistic regression model, age and levels of UA, direct bilirubin (DBIL), and gamma-glutamyl transpeptidase (GGT) were important risk factors for predicting AF. ROC analysis showed that DBIL levels were predictive of AF, with a specificity of 0.813, a sensitivity of 0.767, and an area under the curve of 0.8515 (P < 0.001). CONCLUSION Older age and levels of UA, DBIL, and GGT influenced the occurrence of AF in thyrotoxic patients receiving RAI. DBIL level was an important factor in predicting AF in patients with hyperthyroidism. Thus, thyrotoxic patients who have the above-mentioned risk factors should undergo routine pulse palpation should be considered for active antithyroid drug therapy.
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Liu CF, Zhou WN, Guo TM, Hou AC, Wei YJ. Liver Enzymes and the Risk of Atrial Fibrillation: A Meta-Analysis of Prospective Cohort Studies. Genet Test Mol Biomarkers 2019; 23:865-870. [PMID: 31821094 DOI: 10.1089/gtmb.2019.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Cun-Fei Liu
- Department of Cardiology, Linyi People's Hospital, Linyi City, China
| | - Wei-Ning Zhou
- Department of Pathology, Linyi People's Hospital, Linyi City, China
| | - Tang-Meng Guo
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Cheng Hou
- Department of Cardiology, Linyi People's Hospital, Linyi City, China
| | - Yan-Jin Wei
- Department of Cardiology, Linyi People's Hospital, Linyi City, China
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Arellano-Orden E, Bacopoulou F, Baicus C, Bonfrate L, Broadbent J, Buechler C, Carbone F, Charmandari E, Davis GR, Dullaart RPF, Efthymiou V, Goeser F, Goswami N, Jong GP, Lichtenauer M, Liou YS, Lutz P, Maeng M, Mert GÖ, Mert KU, Montecucco F, Ndrepepa G, Olesen KKW, Oliveira P, Perton FG, Portincasa P, Rodriguez-Panadero F, Schernthaner C, Schutte R. Research update for articles published in EJCI in 2017. Eur J Clin Invest 2019; 49:e13163. [PMID: 31524285 DOI: 10.1111/eci.13163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Elena Arellano-Orden
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocio, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), Seville, Spain.,Center for Biomedical Research in Respiratory Diseases Network, Carlos III Health Institute, Madrid, Spain
| | - Flora Bacopoulou
- First Department of Pediatrics, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Cristian Baicus
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Leonilde Bonfrate
- Department of Biomedical Sciences & Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - James Broadbent
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Christa Buechler
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.,Division of Endocrinology and Metabolism, Clinical, Experimental Surgery and Translational Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Greggory R Davis
- Red Lerille's/LEQSF Regents Endowed Professor in Health and Physical Education, University of Louisiana at Lafayette, Lafayette, LA, USA
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vasiliki Efthymiou
- First Department of Pediatrics, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Felix Goeser
- Department of Internal Medicine I, University of Bonn, Bonn, German.,German Center for Infection Research, Bonn, Germany
| | - Nandu Goswami
- Physiology Division, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - Gwo-Ping Jong
- Division of Internal Cardiology, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan ROC
| | | | - Yi-Sheng Liou
- Department of Family Medicine, Taichung Veteran General Hospital, Taichung, ROC.,School of Public Health, National Defense Medical Center, Taipei, Taiwan ROC
| | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, Bonn, German.,German Center for Infection Research, Bonn, Germany
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Gurbet Özge Mert
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | | | | | - Paulo Oliveira
- CNC - Center for Neuroscience and Cell Biology, UC-Biotech, University of Coimbra, Cantanhede, Portugal
| | - Frank G Perton
- Laboratory Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Piero Portincasa
- Department of Biomedical Sciences & Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - Francisco Rodriguez-Panadero
- Medical-Surgical Unit of Respiratory Diseases, University Hospital Virgen del Rocio, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | | | - Rudolph Schutte
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
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Käräjämäki AJ, Hukkanen J, Ukkola O. The association of non-alcoholic fatty liver disease and atrial fibrillation: a review. Ann Med 2018; 50:371-380. [PMID: 29929399 DOI: 10.1080/07853890.2018.1492147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is highly prevalent and causes an enormous burden to human health and health-care systems all over the world. A great proportion of this burden results from increased risk of cardiovascular diseases. Atrial fibrillation (AF) is the most common chronic heart arrhythmia globally and it increases the risk of embolic stroke and heart failure. Recent studies have explored the association between NAFLD and AF with somewhat conflicting results. However, ultrasound-verified prospective studies concur that NAFLD is associated with the incidence of AF. According to epidemiological evidence, the greater the prevalence of NALFD in a population, the stronger the association with AF incidence and prevalence. Specifically, diabetic individuals with NAFLD are at the greatest risk of AF. Additionally, the risk of AF may concentrate most in individuals with advanced NAFLD, particularly those with liver fibrosis. The possible mechanistic factors between NAFLD and AF, particularly obesity and systemic inflammation, are diverse and form a complex interplaying network. However, further studies are needed to elucidate whether NAFLD has a causative role in the development of AF. The purpose of this article is to review and discuss the epidemiologic evidence and possible mechanistic links between these two conditions. KEY MESSAGES Although epidemiologic studies have provided conflicting results on the association of NAFLD and AF, prospective studies with ultrasound-verified NAFLD concur that NAFLD is associated with about 2-fold greater incidence of AF among general population and about 6-fold greater incidence among subjects with type 2 diabetes. The risk of AF among individuals with NAFLD is increased by other cardiovascular risk factors, especially type 2 diabetes and advanced age. The possible mechanistic links between NALFD and AF are diverse, with obesity and systemic inflammation having a significant role, but further studies are needed until NAFLD can be established as a causal factor in the incidence of AF.
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Affiliation(s)
- Aki Juhani Käräjämäki
- a Department of Gastroenterology , Clinics of Internal Medicine, Vaasa Central Hospital , Vaasa , Finland.,b Research Unit of Internal Medicine, Medical Research Center Oulu , Oulu University Hospital, and University of Oulu , Oulu , Finland
| | - Janne Hukkanen
- b Research Unit of Internal Medicine, Medical Research Center Oulu , Oulu University Hospital, and University of Oulu , Oulu , Finland
| | - Olavi Ukkola
- b Research Unit of Internal Medicine, Medical Research Center Oulu , Oulu University Hospital, and University of Oulu , Oulu , Finland
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