Frederik Kostka, Till Ittermann, Stefan Groß, Fabian C. Laqua, Robin Bülow, Henry Völzke, Marcus Dörr, Jens-Peter Kühn, Marcello R. P. Markus, Marie‐Luise Kromrey

• Background and Aims Non‐alcoholic fatty liver disease (NAFLD) is associated with increased risk for cardiovascular disease. Our study investigates the contribution of NAFLD to changes in cardiac structure and function in a general population. Methods One thousand ninety‐six adults (49.3% female) from the Study of Health in Pomerania underwent magnetic resonance imaging including cardiac and liver imaging. The presence of NAFLD by proton density fat fraction was related to left cardiac structure and function. Results were adjusted for clinical confounders using multivariable linear regression model. Results The prevalence for NAFLD was 35.9%. In adjusted multivariable linear regression models, NAFLD was positively associated with higher left ventricular mass index (β = 0.95; 95% confidence interval (CI): 0.45; 1.45), left ventricular concentricity (β = 0.043; 95% CI: 0.031; 0.056), left ventricular end‐diastolic wall thickness (β = 0.29; 95% CI: 0.20; 0.38), left atrial end‐diastolic volume index (β = 0.67; 95% CI: 0.01; 1.32) and inversely associated with left ventricular end‐diastolic volume index (β = −0.78; 95% CI: −1.51; −0.05). When stratified by sex, we only found significant positive associations of NAFLD with left ventricular mass index, left atrial end‐diastolic volume index, left ventricular cardiac output and an inverse association with global longitudinal strain in women. In contrast, men had an inverse association with left ventricular end‐diastolic volume index and left ventricular stroke volume. Higher liver fat content was stronger associated with higher left ventricular mass index, left ventricular concentricity and left ventricular end‐diastolic wall thickness. Conclusion NAFLD is associated with cardiac remodelling in the general population showing sex specific patterns in cardiac structure and function.