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Diabetes Metab J. 2019 Feb 28. doi: 10.4093/dmj.2019.0001. [Epub ahead of print]

Association between Non-Alcoholic Steatohepatitis and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus.

Lee H1,2, Kim G3, Choi YJ4, Huh BW4, Lee BW1,5, Kang ES1,5,6, Cha BS1,5,6, Lee EJ1,5,6, Lee YH7,5,6,8, Huh KB4.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
2
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
3
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4
Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.
5
Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
6
Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
7
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. yholee@yuhs.ac.
8
Department of Systems Biology, Glycosylation Network Research Center, Yonsei University, Seoul, Korea.

Abstract

BACKGROUND:

Impaired diastolic heart function has been observed in persons with non-alcoholic fatty liver disease (NAFLD) and/or with type 2 diabetes mellitus (T2DM). However, it is unclear whether NAFLD fibrotic progression, i.e., non-alcoholic steatohepatitis, poses an independent risk for diastolic dysfunction in T2DM. We investigated the association between liver fibrosis and left ventricular (LV) diastolic dysfunction in T2DM.

METHODS:

We analyzed 606 patients with T2DM, aged ≥50 years, who had undergone liver ultrasonography and pulsed-wave Doppler echocardiography. Insulin sensitivity was measured by short insulin tolerance test. Presence of NAFLD and/or advanced liver fibrosis was determined by abdominal ultrasonography and NAFLD fibrosis score (NFS). LV diastolic dysfunction was defined according to transmitral peak early to late ventricular filling (E/A) ratio and deceleration time, using echocardiography.

RESULTS:

LV diastolic dysfunction was significantly more prevalent in the NAFLD versus non-NAFLD group (59.7% vs. 49.0%, P=0.011). When NAFLD was stratified by NFS, subjects with advanced liver fibrosis exhibited a higher prevalence of diastolic dysfunction (49.0%, 50.7%, 61.8%; none, simple steatosis, advanced fibrosis, respectively; P for trend=0.003). In multivariable logistic regression, liver fibrosis was independently associated with diastolic dysfunction (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.07 to 2.34; P=0.022) after adjusting for insulin resistance and cardiometabolic risk factors. This association remained significant in patients without insulin resistance (OR, 4.32; 95% CI, 1.73 to 11.51; P=0.002).

CONCLUSIONS:

Liver fibrosis was associated with LV diastolic dysfunction in patients with T2DM and may be an independent risk factor for diastolic dysfunction, especially in patients without systemic insulin resistance.

KEYWORDS:

Diabetes mellitus, type 2; Diabetic cardiomyopathies; Heart failure; Insulin resistance; Non-alcoholic fatty liver disease

PMID:
30877708
DOI:
10.4093/dmj.2019.0001
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