DAY 2: Echocardiography Can Act as an Early Screening Tool for Steatotic Liver Disease

Incorporating hepatic imaging into cardiac evaluations may help detect metabolic dysfunction-associated steatotic liver disease (MASLD) early and prevent disease progression, according to findings presented at the 2026 Annual Scientific Meeting of the American College of Gastroenterology in Nashville, Tennessee. 

MASLD has become the most common chronic liver disease worldwide, affecting more than one-third of the global population [Miller DM et al. Endocrinol Diabetes Metab 2025; 8(6):e70132]. Because MASLD is typically silent in the early stages and patients often present with normal levels of liver enzymes, the disease may progress and cause complications before patients receive subspecialty care. People with MASLD often present with other cardiometabolic risk factors, such as obesity, type 2 diabetes, and dyslipidemia. Nevertheless, hepatic evaluations are not typically incorporated into standard cardiology protocols, even though MASLD is a well-established risk factor for adverse cardiac remodeling, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction [Sonaglioni A et al. J Clin Med 2025;14(8):2690]. 

Recent clinical data have suggested that the echocardiography-derived hepatorenal index (HRI) may have value as a screening tool for detecting MASLD. The HRI measures hepatic steatosis by comparing the echogenicity of the liver to the right renal cortex. While traditionally performed via abdominal ultrasound, echocardiography-derived HRI enables clinicians to opportunistically screen for MASLD during routine cardiac evaluations. 

A study conducted an at academic center in India showed that echocardiography-derived HRI performed similarly to liver enzyme tests as a predictor of MASLD. The prospective study has, so far, included 162 adults who underwent clinically indicated transthoracic echocardiography at a medical center in Kota, India. Participants underwent multiple investigations, including testing of the fasting serum liver enzymes and triglyceride levels. Steatosis was identified in 102 patients, representing 63% of the cohort. HRI showed high sensitivity and specificity (both higher than 90%) for detecting steatosis, and was highly accurate (92%) as a predictor of MASLD. The index correlated well with traditional tests used to screen for MASLD, and performed as well as liver enzyme and triglyceride tests, without requiring blood draws. The researchers noted that its greatest added value lies in the non-discriminatory body mass index, which could benefit overweight patients and those with obesity. 

“HRI-triggered hepatology referral offers a clinically meaningful advantage in reducing the burden of further investigations in patients with [initial] negative screening [results],” said presenting author Komal Verma Saluja, MBBS, a physician affiliated with the Government Medical College in Kota, noting that “HRI converts every echocardiography into an opportunistic liver screen.”