Research
Hormonal
Advanced stages of MASLD (fibrosis/MASH) causally contribute to heart failure with preserved ejection fraction (HFpEF) through mechanical impediments to hepatic blood flow, reducing right ventricular preload.
If you have advanced liver fibrosis, monitor for signs of heart failure (fatigue, shortness of breath) even if your heart structure looks normal. The stiffness of your liver can mechanically impede blood flow back to the heart, contributing to HFpEF. Managing liver inflammation may help cardiac preload.
ModerateSupportsMEDIUM confidence
In the more advanced fibrotic stages, MASLD may contribute to heart failure with preserved ejection fraction by reduced filling of the right ventricle, which may induce fatigue upon exertion... A putative mechanism in which MASLD per se might cause heart failure with preserved ejection fraction is through reducing the preload reserve.
Why this rating
Based on mechanistic models and observational studies; causality is suggested but not definitively proven in large RCTs.
Source
Metabolic dysfunction-associated steatotic liver disease and the heart
Stan Driessen et al. · Hepatology · 2023
DOI 10.1097/hep.0000000000000735
narrative_reviewCited 94×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with increased subclinical atherosclerosis (measured by carotid intima-media thickness and coronary artery calcification) and incident cardiovascular events, but does not independently increase cardiovascular mortality risk after adjusting for confounders.Good
- Mendelian randomization studies suggest that genetic predisposition to MASLD via impaired VLDL secretion (PNPLA3, TM6SF2) may lower plasma lipids and potentially reduce coronary artery disease risk, whereas other MASLD genes show weak or no association with CAD.Moderate
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