Nonalcoholic Fatty Liver Disease Is Associated With Left Ventricular Diastolic Dysfunction in Patients With Type 2 Diabetes
Open Access
- 16 January 2012
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 35 (2), 389-395
- https://doi.org/10.2337/dc11-1820
Abstract
OBJECTIVE Data on cardiac function in patients with nonalcoholic fatty liver disease (NAFLD) are limited and conflicting. We assessed whether NAFLD is associated with abnormalities in cardiac function in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We studied 50 consecutive type 2 diabetic individuals without a history of ischemic heart disease, hepatic diseases, or excessive alcohol consumption, in whom NAFLD was diagnosed by ultrasonography. A tissue Doppler echocardiography with myocardial strain measurement was performed in all patients. RESULTS Thirty-two patients (64%) had NAFLD, and when compared with the other 18 patients, age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, and medication use were not significantly different. In addition, the left ventricular (LV) mass and volumes, ejection fraction, systemic vascular resistance, arterial elasticity, and compliance were also not different. NAFLD patients had lower e′ (8.2 ± 1.5 vs. 9.9 ± 1.9 cm/s, P < 0.005) tissue velocity, higher E-to-e′ ratio (7.90 ± 1.3 vs. 5.59 ± 1.1, P < 0.0001), a higher time constant of isovolumic relaxation (43.1 ± 10.1 vs. 33.2 ± 12.9 ms, P < 0.01), higher LV–end diastolic pressure (EDP) (16.5 ± 1.1 vs. 15.1 ± 1.0 mmHg, P < 0.0001), and higher LV EDP/end diastolic volume (0.20 ± 0.03 vs. 0.18 ± 0.02 mmHg, P < 0.05) than those without steatosis. Among the measurements of LV global longitudinal strain and strain rate, those with NAFLD also had higher E/global longitudinal diastolic strain rate during the early phase of diastole (E/SRE). All of these differences remained significant after adjustment for hypertension and other cardiometabolic risk factors. CONCLUSIONS Our data show that in patients with type 2 diabetes and NAFLD, even if the LV morphology and systolic function are preserved, early features of LV diastolic dysfunction may be detected.This publication has 36 references indexed in Scilit:
- Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific DeathThe New England Journal of Medicine, 2011
- National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participantsThe Lancet, 2011
- Standards of Medical Care in Diabetes—2011Diabetes Care, 2011
- Diagnostic approaches for diabetic cardiomyopathy and myocardial fibrosisJournal of Molecular and Cellular Cardiology, 2010
- Non-alcoholic fatty liver disease: The mist gradually clearsJournal of Hepatology, 2008
- Obesity-Associated Liver DiseaseJournal of Clinical Endocrinology & Metabolism, 2008
- Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and managementHepatology, 2008
- Diastolic Dysfunction and Diabetic Cardiomyopathy: Evaluation by Doppler EchocardiographyJournal of the American College of Cardiology, 2006
- Diabetic Cardiomyopathy: Evidence, Mechanisms, and Therapeutic ImplicationsEndocrine Reviews, 2004
- Echocardiographic detection of early diabetic myocardial diseaseJournal of the American College of Cardiology, 2003