Electrocardiographic Abnormalities in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis

Introduction This study review aimed to consolidate current knowledge on the electrocardiographic abnormalities observed in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD). Methods This was a systematic review of studies on the association between MASLD and electrocardiographic abnormalities, published between January 1, 1946, and October 31, 2023. Data from eligible studies were extracted, analyzed, synthesized, and summarized. Results We evaluated a total of 27 studies with 8,607,500 participants overall and 1,005,101 participants with MASLD. There was a statistically significant association between MASLD and prevalent atrial fibrillation (pooled OR: 1.34 95% CI: 1.20 – 1.49, p<0.001, n=12), shorter QRS duration (pooled SMD: -0.073, 95% CI: -0.144 – -0.001, n = 2, p=0.048, n=2), QTc prolongation (p<0.001, n=2), LVH (pooled OR: 1.48, 95% CI: 1.25 – 1.75, p<0.001, n=3), low voltage (P<0.001, n=1), ST changes (OR: 1.41, 95% CI: 1.04 – 1.91, p=0.027, n=1), T wave inversion (p<0.001, n=1), axis deviation (OR: 3.21, 95% CI: 1.99 – 5.17, p<0.001, n=1), conduction defect (OR: 2.79, 95% CI: 1.83 – 4.26, p<0.001, n=1) and bundle branch block (OR: 2.90, 95% CI: 1.82 – 4.61, p<0.001, n=1), any persistent heart block (p<0.001, n=1), fragmented QRS (p<0.001, n=1), and P wave diversion (p = 0.0001, n=1) Conclusion MASLD is associated with multiple ECG abnormalities which are potential markers of early cardiac involvement, highlighting the multisystemic nature of MASLD. These specific ECG abnormalities could be used in screening and management algorithms to improve cardiac risk stratification in MASLD patients. PROSPERO Registration CRD42023477501