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Association of non-alcoholic steatohepatitis with subclinical myocardial dysfunction in non-cirrhotic patients

Authors
 Yong-Ho Lee  ;  Kwang Joon Kim  ;  Myung Eun Yoo  ;  Gyuri Kim  ;  Hye-Jin Yoon  ;  Kwanhyeong Jo  ;  Jong-Chan Youn  ;  Mijin Yun  ;  Jun Yong Park  ;  Chi Young Shim  ;  Byung-Wan Lee  ;  Seok-Min Kang  ;  Jong-Won Ha  ;  Bong-Soo Cha  ;  Eun Seok Kang 
Citation
 Journal of Hepatology, Vol.68(4) : 764-772, 2018 
Journal Title
 Journal of Hepatology 
ISSN
 0168-8278 
Issue Date
2018
Keywords
Diastolic heart dysfunction ; Insulin resistance ; Liver fibrosis ; Non-alcoholic fatty liver disease ; Obesity ; Positron emission tomography
Abstract
BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular risk. Among categories of NAFLD, hepatic fibrosis is most likely to affect mortality. Myocardial function and its energy metabolism are tightly linked, which might be altered by an insulin resistant condition such as NAFLD. We investigated whether hepatic steatosis and fibrosis were associated with myocardial dysfunction relative to myocardial glucose uptake. METHODS: A total of 308 patients (190 without NAFLD, 118 with NAFLD) were studied in a tertiary care hospital. Myocardial glucose uptake was evaluated at fasted state using [(18)F]-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET). Hepatic steatosis and fibrosis were assessed by transient liver elastography (Fibroscan(R)) with controlled attenuation parameter, which quantifies hepatic fat and by surrogate indices (fatty liver index and NAFLD fibrosis score). Cardiac structure and function were examined by echocardiogram. RESULTS: Compared to those without NAFLD, patients with NAFLD had alterations in cardiac remodeling, manifested by increased left ventricular mass index, left ventricular end-diastolic diameter, and left atrial volume index (all p<0.05). Hepatic steatosis was significantly associated with left ventricular filling pressure (E/e' ratio), which reflects diastolic dysfunction (p for trend <0.05). Those without NAFLD were more likely to have higher myocardial glucose uptake compared to those with NAFLD. Significant hepatic fibrosis was also correlated with diastolic dysfunction and impaired myocardial glucose uptake. Using multivariable linear regression, E/e' ratio was independently associated with hepatic fibrosis (standardized beta=0.12 to 0.27; all p<0.05). Association between hepatic steatosis and E/e' ratio was also significant (standardized beta=0.10 to 0.15; all p<0.05 excluding the model adjusted for adiposity). CONCLUSIONS: Hepatic steatosis and fibrosis are significantly associated with diastolic heart dysfunction. This association is linked with myocardial glucose uptake evaluated by (18)FDG-PET. LAY SUMMARY: Non-alcoholic fatty liver disease is associated with an increased risk of cardiovascular disease. More severe forms of non-alcoholic fatty liver disease, where hepatic fibrosis occurs, are linked to increased mortality. In this study, we have shown that hepatic steatosis and fibrosis are associated with subclinical myocardial dysfunction. This association is linked to altered myocardial glucose uptake.
Full Text
https://www.sciencedirect.com/science/article/pii/S0168827817324480
DOI
10.1016/j.jhep.2017.11.023
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실)
Yonsei Authors
강석민(Kang, Seok Min) ORCID logo https://orcid.org/0000-0001-9856-9227
강은석(Kang, Eun Seok) ORCID logo https://orcid.org/0000-0002-0364-4675
김광준(Kim, Kwang Joon) ORCID logo https://orcid.org/0000-0002-5554-8255
김규리(Kim, Gyuri)
박준용(Park, Jun Yong) ORCID logo https://orcid.org/0000-0001-6324-2224
심지영(Shim, Chi Young)
유명은(Yoo, Myung Eun)
윤미진(Yun, Mi Jin) ORCID logo https://orcid.org/0000-0002-1712-163X
윤종찬(Youn, Jong Chan)
이병완(Lee, Byung Wan)
이용호(Lee, Yong Ho) ORCID logo https://orcid.org/0000-0002-6219-4942
차봉수(Cha, Bong Soo) ORCID logo https://orcid.org/0000-0003-0542-2854
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162242
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