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 individuals without cardiovascular disease. Material and methods . This cross-sectional study included 303 patients without cardiovascular diseases 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 was considered diagnostic criteria for hepatic steatosis according to the original formulas. Results . Sex distribution in the study cohort was balanced (49.8% men and 50.2% women). The prevalence of arterial hypertension was 66.3%, 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) (ρ =0.401, ρ =0.507, ρ =0.545, and ρ =0.622, respectively). AC demonstrated the highest diagnostic performance for EO detection (AUC=0.715; 95% CI: 0.575-0.855; p=0.002). Similar results were obtained for FLI (AUC=0.722; 95% CI: 0.598-0.847; 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). Statistically significant differences between the ROC curves (p=0.0417) were confirmed. 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.