The Role of Non-Invasive Markers of Hepatic Steatosis in Detecting Epicardial Obesity

Aim. To evaluate the diagnostic value of various non-invasive methods for assessing hepatic steatosis as potential markers of epicardial obesity (EO) in the studied population.

Materials and methods. This cross-sectional study included 303 patients with a median age of 55 [40;65] years. Epicardial adipose tissue (EAT) thickness was assessed by echocardiography, and EO was determined according to age-specific threshold values. Hepatic steatosis was verified using liver transient elastography with measurement of the controlled  attenuation coefficient (AC) and hepatorenal index (HRI). AC >0.67 dB/cm/MHz was used as the criterion for hepatic steatosis. The cutoff value for HRI was >1.49. In addition, validated non-invasive indices, including the Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI), were calculated. FLI >60 and HSI >36 were considered diagnostic criteria for hepatic steatosis according to the original formulas. Statistical analysis was performed using Statistica 12.0 software. Comparison of correlated ROC curves and assessment of statistically significant differences between them were performed using the nonparametric DeLong’s test.

Results. Sex distribution in the study cohort was balanced (49.8% men and 50.2% women). The prevalence of arterial hypertension was 69.3%, dyslipidemia 46.8%, and abdominal obesity 50.4%. EO was detected in 68% of patients. The prevalence of hepatic steatosis assessed by ultrasonography with AC measurement was 41.3%, while HRI-based steatosis was detected in 45% of patients. According to calculated indices, hepatic steatosis was identified in 50.1% of patients using HSI and in 32.3% using FLI. Statistically significant correlations were observed between EAT thickness and hepatic steatosis markers (HSI, FLI, HRI, and AC) (r=0.401, r=0.507, r=0.545, and r=0.622, respectively). AC demonstrated the highest diagnostic performance for EO detection (AUC=0.715; 95% CI: 4.04-18.54; p=0.002). Similar results were obtained for FLI (AUC=0.722; 95% CI: 0.01-0.04; p=0.003). Pairwise comparisons revealed statistically significant differences between AC and HSI (p=0.044), as well as between HSI and FLI (p=0.007). The overall DeLong test confirmed statistically significant differences between the ROC curves (p=0.0417). ROC analysis was additionally performed to determine cutoff values of AC and FLI for EO detection. The optimal AC cutoff value was 0.65 dB/cm/MHz (specificity 70.91%, sensitivity 88%), whereas the optimal FLI cutoff value was 29 (specificity 68.97%, sensitivity 75.44%).

Conclusion. The identified associations between hepatic steatosis markers (FLI, HSI, HRI, and AC) and EO are consistent with the concept of a “metabolic dysfunction cluster,” according to which hepatic steatosis may reflect the severity of metabolic disturbances and serve as a marker of cardiovascular risk.

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