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

 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 
 Journal of Hepatology, Vol.68(4) : 764-772, 2018 
Journal Title
 Journal of Hepatology 
Issue Date
Diastolic heart dysfunction ; Insulin resistance ; Liver fibrosis ; Non-alcoholic fatty liver disease ; Obesity ; Positron emission tomography
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kang, Eun Seok(강은석) ORCID logo https://orcid.org/0000-0002-0364-4675
Kim, Kwang Joon(김광준) ORCID logo https://orcid.org/0000-0002-5554-8255
Kim, Gyuri(김규리)
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Yoo, Myung Eun(유명은) ORCID logo https://orcid.org/0000-0002-8616-0253
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Youn, Jong Chan(윤종찬)
Lee, Byung Wan(이병완) ORCID logo https://orcid.org/0000-0002-9899-4992
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
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