Investigators have revealed an association between atrial fibrillation and liver stiffness. These results are published in the PLOS One journal.
Atrial fibrillation is the most common cardiac rhythm abnormality and several underlying causes have been hypothesized for its causation. Aging, obesity, coronary artery disease, alcohol, and diabetes are now considered as the most known reasons. Liver fibrosis is one of these novel hypothesized reasons.
Liver fibrosis, which is the underlying etiology for end-stage liver damage, liver failure, liver cirrhosis and hepatocellular carcinoma, evolves from a variety of underlying reasons. Non-alcoholic fatty liver disease (NAFLD), aging, and diabetes are the most known causes. NAFLD is the most prevalent cause of liver fibrosis in North America. Fortunately, each of these conditions (except, of course, aging) is preventable and partially reversible.
A recent PLOS One article has evaluated the presence of atrial fibrillation in patients with liver stiffness in an elderly Finnish population.
This cross-sectional study enrolled a total number of 149 elderly patients with atrial fibrillation. Half of these patients were diagnosed with NAFLD and the other half did not have any hepatic abnormalities. They underwent extensive clinical measurements including echocardiography of the heart, transient elastography (TE) of the liver and were evaluated for the presence of atrial fibrillation.
Results have demonstrated that subjects with atrial fibrillation had higher transient elastography (TE) values (stiffer liver). When the cohort was divided into four subgroups (those without NAFLD or atrial fibrillation, with NAFLD but without atrial fibrillation, with both conditions, and with atrial fibrillation but without NAFLD), the TE value was highest in subjects with both conditions. Moreover, the higher the TE value, the more prevalent atrial fibrillation was. Additionally, there was a higher prevalence of left atrial enlargement in patients with stiffer livers; an enlarged left atrium is another predictor and underlying etiology for atrial fibrillation.
As a novel hypothesis, this evaluation is the only study showing an association between liver stiffness and atrial fibrillation. Since the study was a cohort study, a causal relationship could not be concluded, thus requiring more studies to be done in order to clarify if the association is causal or correlative.
Written By: Nima Makhdami, M.D.