Association between Non-alcoholic steatohepatitis and left ventricular diastolic dysfunction in type 2 diabetes mellitus

Hokyou Lee, Gyuri Kim, Young Ju Choi, Byung Wook Huh, Byung Wan Lee, Eun Seok Kang, Bong Soo Cha, Eun Jig Lee, Yong Ho Lee, Kap Bum Huh

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5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
JournalDiabetes and Metabolism Journal
Volume44
Issue number2
DOIs
Publication statusPublished - 2020 Apr

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea (NRF) grant from the Ministry of Science and ICT (NRF-2016R1A5A1010764) and by the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare (HI17C0913). The authors would like to thank Caron Modeas, University of North Carolina at Chapel Hill, for proofreading.

Publisher Copyright:
© 2020 Korean Diabetes Association https://e-dmj.org

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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