Cardiac Structural Alterations in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Cross-Sectional Analysis at a Tertiary Care Center

Abstract Background: Metabolic dysfunction Associated Steatotic Liver Disease (MASLD) is increasingly recognized as a systemic cardiometabolic disorder. Data on subclinical cardiac alterations from tertiary care centers in South Asia remain limited. Objective: To evaluate cardiac structural and functional alterations by 2D echocardiography in MASLD patients compared with controls, and to examine their relationship with hepatic fibrosis severity. Methods: This cross-sectional study enrolled 50 MASLD patients and 20 age- and sex-matched controls. MASLD was diagnosed by liver ultrasonography meeting 2023 consensus criteria. Hepatic fibrosis was assessed by FIB-4 index, APRI, and transient elastography. All participants underwent standard 2D transthoracic echocardiography assessing Left Ventricular (LV) Mass Index (LVMI), wall thickness, ejection fraction, and diastolic parameters. Results: Mean patient age was 47.2±9.8 years (female-to-male ratio 1.38:1). LV hypertrophy was present in 60% of MASLD patients (as an isolated finding in 40%, and co-existing with diastolic dysfunction in a further 20%), while isolated diastolic dysfunction was present in an additional 20%; overall 80% demonstrated at least one echocardiographic abnormality versus 10% of controls. Ejection fraction was preserved in all participants. Binary logistic regression yielded an odds ratio of 28.5 (95% CI 5.8-139.4) for any echocardiographic abnormality in MASLD versus controls. Mild to-moderate fibrosis (F0-F2) was present in 88% and moderate-to-severe fibrosis (F3-F4) in 12%, with more pronounced cardiac alterations in the latter subgroup. Conclusion: MASLD is independently associated with subclinical cardiac structural and functional alterations even at low-to-moderate fibrosis stages, mandating routine echocardiographic surveillance in this population.