Levelt Eylem, Pavlides Michael, Banerjee Rajarshi, Mahmod Masliza, Kelly Catherine, Sellwood Joanna, Ariga Rina, Thomas Sheena, Francis Jane, Rodgers Christopher, Clarke William, Sabharwal Nikant, Antoniades Charalambos, Schneider Jurgen, Robson Matthew, Clarke Kieran, Karamitsos Theodoros, Rider Oliver, Neubauer Stefan
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom.
J Am Coll Cardiol. 2016 Jul 5;68(1):53-63. doi: 10.1016/j.jacc.2016.03.597.
Type 2 diabetes (T2D) and obesity are associated with nonalcoholic fatty liver disease, cardiomyopathy, and cardiovascular mortality. Both show stronger links between ectopic and visceral fat deposition, and an increased cardiometabolic risk compared with subcutaneous fat.
This study investigated whether lean patients (Ln) with T2D exhibit increased ectopic and visceral fat deposition and whether these are linked to cardiac and hepatic changes.
Twenty-seven obese patients (Ob) with T2D, 15 Ln-T2D, and 12 normal-weight control subjects were studied. Subjects underwent cardiac computed tomography, cardiac magnetic resonance imaging (MRI), proton and phosphorus MR spectroscopy, and multiparametric liver MR, including hepatic proton MRS, T1- and T2*-mapping yielding "iron-corrected T1" [cT1].
Diabetes, with or without obesity, was associated with increased myocardial triglyceride content (p = 0.01), increased hepatic triglyceride content (p = 0.04), and impaired myocardial energetics (p = 0.04). Although cardiac structural changes, steatosis, and energetics were similar between the T2D groups, epicardial fat (p = 0.04), hepatic triglyceride (p = 0.01), and insulin resistance (p = 0.03) were higher in Ob-T2D. Epicardial fat, hepatic triglyceride, and insulin resistance correlated negatively with systolic strain and diastolic strain rates, which were only significantly impaired in Ob-T2D (p < 0.001 and p = 0.006, respectively). Fibroinflammatory liver disease (elevated cT1) was only evident in Ob-T2D patients. cT1 correlated with hepatic and epicardial fat (p < 0.001 and p = 0.01, respectively).
Irrespective of body mass index, diabetes is related to significant abnormalities in cardiac structure, energetics, and cardiac and hepatic steatosis. Obese patients with T2D show a greater propensity for ectopic and visceral fat deposition.
2型糖尿病（T2D）和肥胖与非酒精性脂肪性肝病、心肌病及心血管疾病死亡率相关。二者均显示出异位脂肪和内脏脂肪沉积之间存在更强的联系，且与皮下脂肪相比，心脏代谢风险增加。
本研究调查了T2D瘦患者（Ln）是否表现出异位脂肪和内脏脂肪沉积增加，以及这些是否与心脏和肝脏变化有关。
对27例肥胖T2D患者（Ob）、15例Ln-T2D患者和12例正常体重对照者进行了研究。受试者接受了心脏计算机断层扫描、心脏磁共振成像（MRI）、质子和磷磁共振波谱检查，以及多参数肝脏磁共振检查，包括肝脏质子磁共振波谱、T1和T2*映射，得出“铁校正T1”[cT1]。
无论有无肥胖，糖尿病均与心肌甘油三酯含量增加（p = 0.01）、肝脏甘油三酯含量增加（p = 0.04）及心肌能量代谢受损（p = 0.04）相关。虽然T2D组之间的心脏结构变化、脂肪变性和能量代谢相似，但Ob-T2D组的心外膜脂肪（p = 0.04）、肝脏甘油三酯（p = 0.01）和胰岛素抵抗（p = 0.03）更高。心外膜脂肪、肝脏甘油三酯和胰岛素抵抗与收缩期应变和舒张期应变率呈负相关，而收缩期应变和舒张期应变率仅在Ob-T2D组中显著受损（分别为p < 0.001和p = 0.
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