Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China.
Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
J Nucl Cardiol. 2020 Oct;27(5):1679-1688. doi: 10.1007/s12350-018-1446-x. Epub 2018 Sep 20.
Non-alcoholic fatty liver disease (NAFLD) has emerged as an independent risk factor for cardiovascular diseases. However, there were few studies evaluating the condition of myocardial glucose metabolism in patients with NAFLD. Therefore, the aim of this study was to investigate the association between NAFLD and myocardial glucose uptake assessed by using F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and whether or not alteration of myocardial glucose uptake could be an indicator linking to cardiac dysfunction in NAFLD individuals.
A total of 743 asymptomatic subjects (201 with NAFLD, 542 without NAFLD) were retrospectively studied. The ratio of maximum myocardium FDG uptake to the mean standardized uptake value of liver (SUVratio) was calculated to estimate myocardial glucose uptake by using F-FDG PET. The diagnosis of fatty liver and fatty liver grading was confirmed by unenhanced CT according to diagnostic criterion of previous studies. The myocardial geometric and functional data were obtained by echocardiogram. Myocardial glucose uptake was significantly lower in individuals with NAFLD compared with those without fatty liver (P < .001). When analysis of association trend was performed, SUVratio quartiles showed correlated inversely and strongly with liver steatosis (P < .001). NAFLD patients with lower myocardial glucose uptake were more likely to have higher proportion of increased LV filling pressure (P < .05). A significant relationship between myocardial SUVratio and E/e' ratio was presented in the trend analysis (P < .05). Moreover, multivariate regression analysis showed that myocardial glucose uptake was independently associated with NAFLD after adjusting for clinical important factors (all P < .001).
The presence of NAFLD in otherwise healthy subjects is closely associated with decreased myocardial glucose uptake assessing by F-FDG PET imaging. Furthermore, the NAFLD individuals with lower myocardial glucose uptake are more likely to have high risk of having impaired diastolic heart function.
非酒精性脂肪性肝病（NAFLD）已成为心血管疾病的独立危险因素。然而，评估 NAFLD 患者心肌葡萄糖代谢状况的研究较少。因此，本研究旨在探讨 F-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）评估的 NAFLD 与心肌葡萄糖摄取之间的关系，以及心肌葡萄糖摄取的改变是否可以作为 NAFLD 个体与心脏功能障碍相关的指标。
回顾性研究了 743 例无症状受试者（201 例有 NAFLD，542 例无 NAFLD）。通过 F-FDG PET 计算最大心肌 FDG 摄取与肝脏平均标准化摄取值的比值（SUVratio），以估计心肌葡萄糖摄取。根据既往研究的诊断标准，采用未增强 CT 对脂肪肝和脂肪肝分级进行诊断。通过超声心动图获得心肌几何和功能数据。与无脂肪肝者相比，NAFLD 个体的心肌葡萄糖摄取明显降低（P < .001）。当进行关联趋势分析时，SUVratio 四分位数与肝脂肪变性呈负相关且相关性较强（P < .001）。心肌葡萄糖摄取较低的 NAFLD 患者更有可能出现左心室充盈压升高的比例较高（P < .05）。趋势分析显示，心肌 SUVratio 与 E/e' 比值之间存在显著关系（P < .05）。此外，多元回归分析显示，在调整了临床重要因素后，心肌葡萄糖摄取与 NAFLD 独立相关（均 P < .001）。
在其他方面健康的受试者中，存在 NAFLD 与 F-FDG PET 成像评估的心肌葡萄糖摄取减少密切相关。此外，心肌葡萄糖摄取较低的 NAFLD 个体更有可能存在舒张性心脏功能障碍的高风险。
