Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Health Promotion, Severance Check-up, Health Promotion Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Diabetes Obes Metab. 2021 Apr;23(4):1041-1051. doi: 10.1111/dom.14310. Epub 2021 Jan 15.
To investigate whether degree of nonalcoholic fatty liver disease (NAFLD) is associated with myocardial dysfunction related to impaired myocardial glucose uptake in patients with type 2 diabetes.
In total, 131 patients with type 2 diabetes from a tertiary care hospital were included in this study. Myocardial glucose uptake was assessed using [ F]-fluorodeoxyglucose-positron emission tomography. Hepatic steatosis and fibrosis were determined using transient liver elastography. Echocardiography was performed to evaluate cardiac structure and function.
Patients with NAFLD had cardiac diastolic dysfunction with higher left ventricular filling pressure (E/e' ratio) and left atrial (LA) volume index than patients without NAFLD (all P < 0.05). Hepatic steatosis correlated with E/e' ratio and LA volume index, and hepatic fibrosis also correlated with E/e' ratio (all P < 0.05). Even after adjusting for confounding factors, a higher degree of hepatic steatosis (r = 0.409, P = 0.041) and a higher degree of fibrosis (r = 0.423, P = 0.009) were independent contributing factors to a higher E/e' ratio. Decreased myocardial glucose uptake was associated with a higher degree of steatosis (P for trend = 0.084) and fibrosis (P for trend = 0.012). At the same time, decreased myocardial glucose uptake was an independent contributing factor for a higher E/e' ratio (r = 0.409; P = 0.040).
Hepatic steatosis and fibrosis were significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with impaired myocardial glucose uptake.
研究非酒精性脂肪性肝病（NAFLD）的严重程度是否与 2 型糖尿病患者心肌葡萄糖摄取受损相关的心肌功能障碍有关。
本研究共纳入了一家三级保健医院的 131 例 2 型糖尿病患者。使用 [ F]-氟脱氧葡萄糖正电子发射断层扫描评估心肌葡萄糖摄取。使用瞬时肝脏弹性成像来确定肝脂肪变性和纤维化。通过超声心动图评估心脏结构和功能。
与无 NAFLD 的患者相比，患有 NAFLD 的患者存在舒张性心脏功能障碍，左心室充盈压（E/e' 比值）和左心房（LA）容积指数更高（均 P < 0.05）。肝脂肪变性与 E/e' 比值和 LA 容积指数相关，肝纤维化也与 E/e' 比值相关（均 P < 0.05）。即使在调整了混杂因素后，较高的肝脂肪变性程度（r = 0.409，P = 0.041）和较高的纤维化程度（r = 0.423，P = 0.009）也是 E/e' 比值升高的独立影响因素。心肌葡萄糖摄取减少与更高的脂肪变性程度（趋势 P = 0.084）和纤维化程度（趋势 P = 0.012）相关。同时，心肌葡萄糖摄取减少也是 E/e' 比值升高的独立影响因素（r = 0.409；P = 0.040）。
肝脂肪变性和纤维化与 2 型糖尿病患者舒张性心脏功能障碍显著相关，伴有心肌葡萄糖摄取受损。
