{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:16:39Z","timestamp":1792019799190,"version":"4.4.0"},"reference-count":43,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the 2024 Annual Sun Yat-sen University Basic Research Fund for Universities, Young Faculty Development Program","award":["82000-31610008"],"award-info":[{"award-number":["82000-31610008"]}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2023A1515012417"],"award-info":[{"award-number":["2023A1515012417"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2025A1515011215"],"award-info":[{"award-number":["2025A1515011215"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the basic and Applied Basic Research Foundation of the Science and Technology Plan Project of Guangzhou City","award":["2024A03J0175"],"award-info":[{"award-number":["2024A03J0175"]}]},{"name":"the basic and Applied Basic Research Foundation of the Science and Technology Plan Project of Guangzhou City","award":["2025A04J4244"],"award-info":[{"award-number":["2025A04J4244"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify novel, data-driven phenotypic clusters of metabolic dysfunction-associated fatty liver disease (MAFLD) and investigate their associations with cardiac remodelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Secondary care; a single-centre study in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 3233 participants diagnosed with MAFLD were included in the study. The diagnosis was conducted in accordance with the established criteria for MAFLD. The exclusion criteria encompassed a history of significant cardiovascular or hepatic diseases, as well as excessive alcohol consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Echocardiographic parameters of cardiac structure and function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four distinct clusters were identified. Cluster 1 (n=1381) comprised men with a normal metabolic state and low Fibrosis-4 Index (FIB-4) levels. Cluster 2 (n=453) included men with the highest body mass index (BMI) and uric acid levels. Cluster 3 (n=474) consisted of men with the most severe glucose and lipid metabolic disturbances. Cluster 4 (n=925) comprised women with the highest FIB-4 levels. Compared with Cluster 1, participants in Clusters 2 and 3 exhibited worse cardiac structure and function, including enlargement of the left atrium (LA), right atrium, left ventricular internal end-diastolic dimension, interventricular septum (IVS), left ventricular posterior wall (LVPW) thickness, right ventricular and reduced left ventricular ejection fraction. Conversely, participants in Cluster 4 had better cardiac structure and function compared with those in Cluster 1. After adjusting for confounders, Cluster 2 showed positive associations with the LA, IVS, LVPW, right atrium and right ventricular (all p&lt;0.001), while Cluster 4 showed negative associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The heterogeneity of MAFLD reveals sex-specific patterns of cardiac remodelling: male phenotypes with high BMI and uric acid levels are associated with worse remodelling, whereas a female phenotype characterised by high FIB-4 levels correlates with preserved cardiac function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102845","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T13:00:31Z","timestamp":1763038831000},"page":"e102845","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac remodelling in 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