Trovato Francesca M, Martines Giuseppe F, Catalano Daniela, Musumeci Giuseppe, Pirri Clara, Trovato Guglielmo M
University of Catania, School of Medicine, Department of Clinical and Experimental Medicine, Catania, Italy.
University of Catania, School of Medicine, Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology section, Catania, Italy.
Int J Cardiol. 2016 Oct 15;221:275-9. doi: 10.1016/j.ijcard.2016.06.180. Epub 2016 Jun 29.
Non-alcoholic-fatty-liver-disease (NAFLD) is associated with atherosclerosis, increased cardiovascular risks and mortality. We investigated if, independently of insulin resistance, diet, physical activity and obesity, fatty liver involvement has any relationship with echocardiographic measurements in NAFLD.
660 NAFLD and 791 non-NAFLD subjects, referred to the same out-patients medical unit for lifestyle-nutritional prescription, were studied. Congestive heart failure, myocardial infarction, malignancies, diabetes mellitus, extreme obesity, underweight-bad-nourished subjects and renal insufficiency were exclusion criteria. Liver steatosis was assessed by Ultrasound-Bright-Liver-Score (BLS), left ventricular ejection fraction (LVEF), trans-mitral E/A doppler ratio (diastolic relaxation) and left ventricular myocardial mass (LVMM/m(2)) by echocardiography. Doppler Renal artery Resistive Index (RRI), insulin resistance (HOMA) and lifestyle profile were also included in the clinical assessment.
LVMM/m(2) is significantly greater in NAFLD, 101.62±34.48 vs. 88.22±25.61, p<0.0001 both in men and in women. Ejection fraction is slightly smaller only in men with NAFLD; no significant difference was observed for the E/A ratio. BMI (30.42±5.49 vs. 24.87±3.81; p<0.0001) and HOMA (2.90±1.70 vs. 1.85±1.25; p: 0.0001) were significantly greater in NAFLD patients. By Multiple-Linear-Regression, NAFLD and unhealthy dietary profile are associated also in lean non-diabetic subjects with lower systolic function, independently of BMI, dietary profile, physical activity, RRI and insulin resistance.
NAFLD may be a meaningful early clue suggestive of diminishing heart function, with similar determining factors. NAFLD is amenable to management and improvement by lifestyle change counseling, addressing a dual target: reducing fatty liver, which is easily monitored by ultrasound, and, independently, maintaining a normal heart function.
非酒精性脂肪性肝病（NAFLD）与动脉粥样硬化、心血管风险增加及死亡率相关。我们研究了在不考虑胰岛素抵抗、饮食、体力活动和肥胖的情况下，NAFLD中的脂肪肝累及情况与超声心动图测量值之间是否存在任何关联。
对660例NAFLD患者和791例非NAFLD患者进行了研究，这些患者因生活方式 - 营养处方被转诊至同一门诊医疗单元。充血性心力衰竭、心肌梗死、恶性肿瘤、糖尿病、极度肥胖、体重过轻 - 营养不良的患者以及肾功能不全患者为排除标准。通过超声 - 肝脏明亮评分（BLS）评估肝脏脂肪变性，通过超声心动图评估左心室射血分数（LVEF）、二尖瓣E/A多普勒比值（舒张期松弛）和左心室心肌质量（LVMM/m²）。临床评估还包括多普勒肾动脉阻力指数（RRI）、胰岛素抵抗（HOMA）和生活方式概况。
NAFLD患者的LVMM/m²显著更高，男性为101.62±34.48，女性为88.22±25.61，男性和女性的p值均<0.0001。仅男性NAFLD患者的射血分数略低；E/A比值未观察到显著差异。NAFLD患者的BMI（30.42±5.49 vs. 24.87±3.81；p<0.0001）和HOMA（2.90±1.70 vs. 1.85±1.25；p：0.0001）显著更高。通过多元线性回归分析，在收缩功能较低的瘦型非糖尿病受试者中，NAFLD与不健康的饮食模式也相关，且不受BMI、饮食模式、体力活动、RRI和胰岛素抵抗的影响。
NAFLD可能是提示心脏功能减退的一个有意义的早期线索，且有相似的决定因素。NAFLD可通过生活方式改变咨询进行管理和改善，实现双重目标：减少脂肪肝（可通过超声轻松监测），并独立维持正常心脏功能。
