Nonalcoholic Fatty Liver Disease Is Associated with Ventricular Arrhythmias and Major Cardiovascular Events in Patients with Implantable Cardioverter-defibrillators

Yuan Gao; Xiaoyao Li; Jiandu Yang; Zhuxin Zhang; Zhongli Chen; Sijin Wu; Xiang Cui; Xuan Ma; Xiaogang Guo; Ruohan Chen; Qi Sun; Yan Dai; Shu Zhang; Keping Chen

doi:10.1016/j.hrthm.2024.10.050

Nonalcoholic Fatty Liver Disease Is Associated with Ventricular Arrhythmias and Major Cardiovascular Events in Patients with Implantable Cardioverter-defibrillators

Heart Rhythm. 2024 Oct 25:S1547-5271(24)03511-2. doi: 10.1016/j.hrthm.2024.10.050. Online ahead of print.

Authors

Yuan Gao¹, Xiaoyao Li², Jiandu Yang¹, Zhuxin Zhang¹, Zhongli Chen¹, Sijin Wu¹, Xiang Cui³, Xuan Ma⁴, Xiaogang Guo¹, Ruohan Chen¹, Qi Sun¹, Yan Dai¹, Shu Zhang¹, Keping Chen⁵

Affiliations

¹ Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: [email protected].
³ Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: [email protected].

PMID: 39490951
DOI: 10.1016/j.hrthm.2024.10.050

Abstract

Background: Patients with nonalcoholic fatty liver disease (NAFLD) are at risk for cardiovascular diseases. Less is known about the relationship between NAFLD, ventricular arrhythmias (VAs), and cardiovascular events.

Objective: We sought to evaluate the association between NAFLD and VAs and major cardiovascular events in patients with implantable cardioverter-defibrillators (ICDs).

Methods: A total of 921 patients at high risk of sudden cardiac death who received ICDs were retrospectively analyzed. NAFLD is diagnosed by the presence of hepatic steatosis and lack of secondary causes of hepatic fat accumulation. The primary endpoints were VAs, defined as sustained ventricular tachycardia and ventricular fibrillation documented by the device. The secondary endpoints were cardiac mortality, heart transplantation and rehospitalization for heart failure.

Results: The prevalence of NAFLD in patients with ICDs was 24.2% (223/921). The mean age was 58.5 ± 12.7 years old, and 25.7% were female. During the mean follow-up of 34.8 months, 272 (29.5%) patients achieved primary endpoints, and 171 (18.6%) achieved secondary endpoints. Kaplan-Meier analysis revealed that NAFLD was associated with an increased risk of VAs (HR 3.90, 95% CI: 2.87-5.29, log-rank p < 0.0001) and secondary endpoints (HR 2.04, 95% CI: 1.72-2.94, log-rank p < 0.0001). In adjusted Cox regression models, NAFLD was an independent risk factor for VAs (HR = 3.84, CI: 2.87-5.12, p < 0.001) and secondary endpoints (HR = 2.26, CI: 1.55-3.28, p < 0.001).

Conclusions: In our retrospective cohort, NAFLD is signiﬁcantly associated with VAs and major cardiovascular events in patients with ICDs.

Keywords: Cardiovascular events; Implantable cardioverter–defibrillator; Nonalcoholic fatty liver disease; Sudden cardiac death; Ventricular arrhythmias.