Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
J Hepatol. 2013 Apr;58(4):757-62. doi: 10.1016/j.jhep.2012.11.015. Epub 2012 Nov 22.
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with a twofold greater risk of developing cardiovascular disease. Despite this, little is known about the effect of NAFLD upon cardiac function, limiting our ability to identify therapeutic strategies. This study aimed to address this by defining the effect of NAFLD on cardiac function, structure, and metabolism.
Nineteen adults with NAFLD were age-, sex-, and BMI-matched to healthy controls without liver or metabolic disease. Cardiac structure and function were assessed using high-resolution cardiac MRI and tagging at 3.0 T. High-energy phosphate metabolism was assessed using (31)P-magnetic resonance spectroscopy to measure the PCr/ATP ratio.
Adults with NAFLD had significantly thicker left ventricular walls at systole (14 ± 3 vs. 12 ± 2 mm; p <0.01) and diastole (8 ± 1 vs. 7 ± 1 mm; p <0.01) than those without fatty liver and showed decreased longitudinal shortening (14 ± 3 vs. 17 ± 3%; p <0.01). The eccentricity ratio was significantly higher in the NAFLD group (1.1 ± 0.2 vs. 0.9 ± 0.2 g/ml; p <0.01) indicating concentric remodelling. Peak whole wall strain was higher in the NAFLD group (19 ± 2 vs. 17 ± 3%; p <0.01), as was peak endocardial strain (28 ± 4 vs. 22 ± 5%; p <0.01). Cardiac metabolism, measured by PCr/ATP ratio, was not altered in NAFLD (1.8 ± 0.3 vs. 1.9 ± 0.3; p=0.36).
Significant changes in cardiac structure and function are evident in adults with NAFLD in the apparent absence of metabolic changes or overt cardiac disease. Clinicians should continue to explore therapies to improve cardiac function as a means to modify the excess risk of cardiovascular disease associated with NAFLD.
非酒精性脂肪性肝病（NAFLD）使心血管疾病的发病风险增加两倍。尽管如此，我们对 NAFLD 对心脏功能的影响知之甚少，这限制了我们识别治疗策略的能力。本研究旨在通过明确 NAFLD 对心脏功能、结构和代谢的影响来解决这一问题。
将 19 名患有 NAFLD 的成年人与无肝脏或代谢疾病的健康对照者按年龄、性别和 BMI 匹配。使用 3.0 T 高分辨率心脏 MRI 和标记物评估心脏结构和功能。使用（31）P 磁共振波谱测量 PCr/ATP 比值来评估高能磷酸盐代谢。
与无脂肪肝的成年人相比，患有 NAFLD 的成年人的左心室壁在收缩期（14 ± 3 比 12 ± 2 mm；p <0.01）和舒张期（8 ± 1 比 7 ± 1 mm；p <0.01）明显增厚，并且纵向缩短率降低（14 ± 3 比 17 ± 3%；p <0.01）。NAFLD 组的偏心率明显较高（1.1 ± 0.2 比 0.9 ± 0.2 g/ml；p <0.01），表明为向心性重构。NAFLD 组的全壁峰值应变较高（19 ± 2 比 17 ± 3%；p <0.01），心内膜峰值应变也较高（28 ± 4 比 22 ± 5%；p <0.01）。NAFLD 患者的心脏代谢（通过 PCr/ATP 比值测量）没有改变（1.8 ± 0.3 比 1.9 ± 0.3；p=0.36）。
在无代谢变化或明显心脏疾病的情况下，NAFLD 成年人的心脏结构和功能明显改变。临床医生应继续探索改善心脏功能的治疗方法，以改变与 NAFLD 相关的心血管疾病的过度风险。
