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Review
. 2022 Sep 6;10(9):2204.
doi: 10.3390/biomedicines10092204.

Systematic Review and Meta-Analysis of the Usefulness of Epicardial Fat Thickness as a Non-Invasive Marker of the Presence and Severity of Nonalcoholic Fatty Liver Disease

Lorenzo A Orci  1   2 , François R Jornayvaz  3   4   5 , Christian Toso  1   6 , Karim Gariani  3   4
Affiliations
Review

Systematic Review and Meta-Analysis of the Usefulness of Epicardial Fat Thickness as a Non-Invasive Marker of the Presence and Severity of Nonalcoholic Fatty Liver Disease

Lorenzo A Orci et al. Biomedicines. .

Abstract

We performed a systematic review and meta-analysis to assess the association between epicardial fat thickness (EFT) and nonalcoholic fatty liver disease (NAFLD). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) and was based on a registered protocol (CRD 4201809 5493). We searched Medline and Embase until December 2021 for studies reporting on the association between EFT and NAFLD. Qualitative reviews, meta-analyses and meta-regressions were performed to explore this association. Effect sizes are reported as standardized mean differences. We included 12 studies, comprising 3610 individuals. EFT was evaluated with trans-thoracic echocardiography in nine studies, two studies using cardiac computed tomography and one study using magnetic resonance imaging (MRI). The presence of NAFLD was evaluated using transabdominal liver ultrasound in nine studies. Other studies used histology, magnetic resonance spectroscopy and MRI-derived proton density fat fraction. Liver biopsy was performed to assess the severity of NAFLD in four studies. The random-effects meta-analysis indicated that, as compared to control patients with lean livers, patients with NAFLD displayed significantly higher EFT (standardized mean difference 0.61, 95% confidence interval: 0.47−0.75, p < 0.0001, I2 = 72%). EFT was further significantly higher in patients with severe liver steatosis versus patients with mild−moderate liver steatosis (standardized mean difference 1.21 95% confidence interval: 0.26−2.16, p < 0.001, I2 S = 96%). Through the meta-regression analysis, we found that patients with increasingly higher blood levels of aspartate aminotransferase displayed an increasingly higher depth of association. The current meta-analysis suggests that EFT may represent a useful surrogate for assessing the presence and severity of NAFLD in a non-invasive manner.

Keywords: CT-SCAN; MRI; epicardial fat; non-alcoholic fatty liver disease; non-invasive marker; steatosis; ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the inclusion/exclusion process, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.
Figure 2
Figure 2
Meta-analysis of studies comparing epicardial fat thickness in NAFLD vs. control patients.
Figure 3
Figure 3
Meta-analysis of studies comparing epicardial fat thickness in patients with severe versus mild-to-moderate liver steatosis.
Figure 4
Figure 4
Meta-analysis of studies comparing epicardial fat thickness in patients with severe (F3–F4) versus early (F1–F2) liver fibrosis.
Figure 5
Figure 5
Meta-analysis regression looking at the impact of baseline aspartate (A) and alanine (B) aminotransferase levels on the calculated effect size.
Figure 5
Figure 5
Meta-analysis regression looking at the impact of baseline aspartate (A) and alanine (B) aminotransferase levels on the calculated effect size.
See this image and copyright information in PMC

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