Nonalcoholic fatty liver disease is associated with ventricular arrhythmias and major cardiovascular events in patients with implantable cardioverter-defibrillators

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 end points were VAs, defined as sustained ventricular tachycardia and ventricular fibrillation documented by the device. The secondary end points 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, and 25.7% were female. During the mean follow-up of 34.8 months, 272 (29.5%) patients achieved primary end points and 171 (18.6%) achieved secondary end points. Kaplan-Meier analysis revealed that NAFLD was associated with an increased risk of VAs (hazard ratio [HR], 3.90; 95% confidence interval [CI], 2.87–5.29; log-rank P < .0001) and secondary end points (HR, 2.04; 95% CI, 1.72–2.94; log-rank P < .0001). In adjusted Cox regression models, NAFLD was an independent risk factor for VAs (HR, 3.84; CI, 2.87–5.12; P < .001) and secondary end points (HR, 2.26; CI, 1.55–3.28; P < .001).

Conclusion

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