Liver and heart fibrosis develops simultaneously in patients with alcohol use disorder - a preliminary report of the HALFWAY study

Introduction Alcoholic liver disease (ALD) is the hepatic manifestation of alcohol overconsumption (alcohol use disorder, AUD). Ethanol toxicity, systemic pro-inflammatory cytokines as well as the intestinal microbiota contribute to progression of inflammation and fibrosis in the liver. Fibrogenesis in the heart, with impaired myocardial relaxation, is clinically characterized as diastolic heart dysfunction. The goal of our study is the investigation of circulating metabolites, microbiota signature and clinical characteristics associated with the simultaneous development of liver and heart fibrosis in patients with AUD.

Methods The HALFWAY-Study is a cohort study, recruiting patients with AUD during a detoxification program. 12 months after study inclusion, participants are revisited and liver as well as heart fibrosis is assessed by non-invasive measurements. This is the first preliminary data analysis as participant recruiting is still ongoing.

Results 40 patients were included into the study (females n = 19, males n = 21). Participants were young (mean age 42,4 years ± 7,5), non-obese (body mass index; BMI 24,1 ±4) and non-diabetic (HbA1c 5,1 % (0,6)), ruling out metabolic disease. 95 % of patients report alcohol consumption more than four times a week, with 65 % drinking 7-8 drinks per day and 25 % consuming more than 10 drinks per day. Advanced hepatic fibrosis could be observed in 20 % of study participants (acoustic radiation force impulse; ARFI, cut-off 7 kPa). We could observe a significant correlation between liver stiffness and altered myocardial relaxation displayed by E/e´ (a well-known surrogate marker of diastolic dysfunction, r=0.369, p = 0.021). Moreover, patients with advanced liver fibrosis displayed increased left atrial volume (p = 0.016). In those patients who maintained abstinence (11 participants) over 12 months, liver fibrosis (ARFI, p<0.001) and diastolic dysfunction (E/e´ (p<0.01) significantly improved.

Discussion In patients with AUD liver and heart fibrosis seem to develop simultaneously. Future research needs to identify circulating metabolites associated with hepatic and myocardial fibrogenesis.

Publication History

Article published online:
01 September 2021