Cassidy Sophie, Hallsworth Kate, Thoma Christian, MacGowan Guy A, Hollingsworth Kieren G, Day Christopher P, Taylor Roy, Jakovljevic Djordje G, Trenell Michael I
Cardiovasc Diabetol. 2015 Feb 13;14:23. doi: 10.1186/s12933-015-0187-2.
Both non-alcoholic fatty liver disease (NAFLD) and Type 2 diabetes increase the risk of developing cardiovascular disease. The metabolic processes underlying NAFLD and Type 2 diabetes are part of an integrated mechanism but little is known about how these conditions may differentially affect the heart. We compared the impact of NAFLD and Type 2 diabetes on cardiac structure, function and metabolism.
19 adults with Type 2 diabetes (62 ± 8 years), 19 adults with NAFLD (54 ± 15 years) and 19 healthy controls (56 ± 14 years) underwent assessment of cardiac structure, function and metabolism using high resolution magnetic resonance imaging, tagging and spectroscopy at 3.0 T.
Adults with NAFLD and Type 2 diabetes demonstrate concentric remodelling with an elevated eccentricity ratio compared to controls (1.05 ± 0.3 vs. 1.12 ± 0.2 vs. 0.89 ± 0.2 g/ml; p < 0.05). Despite this, only the Type 2 diabetes group demonstrate significant systolic and diastolic dysfunction evidenced by a reduced stroke index (31 ± 7vs. controls, 38 ± 10, p < 0.05 ml/m2) and reduced E/A (0.9 ± 0.4 vs. controls, 1.9 ± 1.4, p < 0.05) respectively. The torsion to shortening ratio was higher in Type 2 diabetes compared to NAFLD (0.58 ± 0.16 vs. 0.44 ± 0.13; p < 0.05). Significant associations were observed between fasting blood glucose/HbA1c and diastolic parameters as well as the torsion to shortening ratio (all p < 0.05). Phosphocreatine/adenosine triphosphate ratio was not altered in NAFLD or Type 2 diabetes compared to controls.
Changes in cardiac structure are evident in adults with Type 2 diabetes and NAFLD without overt cardiac disease and without changes in cardiac energy metabolism. Only the Type 2 diabetes group display diastolic and subendocardial dysfunction and glycemic control may be a key mediator of these cardiac changes. Therapies should be explored to target these preclinical cardiac changes to modify cardiovascular risk associated with Type 2 diabetes and NAFLD.
非酒精性脂肪性肝病（NAFLD）和2型糖尿病都会增加患心血管疾病的风险。NAFLD和2型糖尿病背后的代谢过程是一个综合机制的一部分，但对于这些疾病如何对心脏产生不同影响却知之甚少。我们比较了NAFLD和2型糖尿病对心脏结构、功能和代谢的影响。
19名2型糖尿病成年人（62±8岁）、19名NAFLD成年人（54±15岁）和19名健康对照者（56±14岁）使用3.0T高分辨率磁共振成像、标记和光谱技术对心脏结构、功能和代谢进行评估。
与对照组相比，患有NAFLD和2型糖尿病的成年人表现出向心性重塑，离心率升高（1.05±0.3对1.12±0.2对0.89±0.2g/ml；p<0.05）。尽管如此，只有2型糖尿病组表现出明显的收缩和舒张功能障碍，分别表现为每搏输出指数降低（31±7对对照组，38±10，p<0.05ml/m2）和E/A降低（0.9±0.4对对照组，1.9±1.4，p<0.05）。2型糖尿病患者的扭转缩短率高于NAFLD患者（0.58±0.16对0.44±0.13；p<0.05）。空腹血糖/HbA1c与舒张参数以及扭转缩短率之间存在显著相关性（均p<0.05）。与对照组相比，NAFLD或2型糖尿病患者的磷酸肌酸/三磷酸腺苷比值未改变。
在没有明显心脏病且心脏能量代谢无变化的2型糖尿病和NAFLD成年人中，心脏结构的变化很明显。只有2型糖尿病组表现出舒张和心内膜下功能障碍，血糖控制可能是这些心脏变化的关键调节因素。应探索针对这些临床前心脏变化的治疗方法，以改变与2型糖尿病和NAFLD相关的心血管风险。
