Insulin resistance and nonalcoholic fatty liver disease associate with increased risk of cardiovascular disease and predict a worse outcome. The underlying mechanisms are yet unclear. We hypothesized that individuals who suffer from their first acute myocardial infarction (MI) already feature not only lower insulin sensitivity (M-value) and ejection fraction (EF), but also higher hepatocellular lipids (HCL) and liver fibrosis scores (MRE) than matched individuals without MI. We compared participants of the DISTEMI (DIabetes and ST-Elevation MI) Study at 6-12 weeks after MI (MI+; n=21, 81% male, 29% type 2 diabetes, age 61±8 years, BMI 26.8±2.8 kg/m2, HbA1c 5.8±1.0%) with humans without MI (MI-; n=34, 71% male, 32% type 2 diabetes, age 57±8 years, BMI 27.8±3.1 kg/m2, HbA1c 5.5±0.6%). Participants were matched by sex, age, HbA1c and body mass index. They underwent a 75-g oral glucose tolerance and hyperinsulinemic-euglycemic clamp tests. HCL, MRE, EF, infarct size and microvascular obstruction (MVO) were measured with 1H-magnetic resonance (MR) spectroscopy and imaging. MI+ had a lower whole-body insulin sensitivity (M-value: 7.3±2.0 vs. MI- 9.0±3.1 mg*kg-1*min-1, p<0.05). HCL was comparable (2.9±2.8% vs. 5.7±6.7%), while MRE was higher in MI+ compared to MI- (2.5±0.4 kPa vs. 2.1±0.4 kPa, p<0.05). EF was lower in MI+ than in MI- (53±16% vs. 65±7%, p<0.05). In MI+, EF correlated negatively with infarct size (r=-0.91) and MVO (r=-0.82) as well as with HbA1c (r=-0.61) and fasting blood glucose (r=-0.61, all p<0.05).
In conclusion, individuals with incident MI have lower insulin sensitivity, reduced ejection fraction and higher liver fibrosis scores, which relate to worse glucose metabolic control and may contribute to increased risk of heart failure after the first MI.
C. Möser: None. O.P. Zaharia: None. M. Rothe: None. J. Hwang: None. P. Bobrov: None. V. Burkart: None. F. Bönner: None. C. Jung: None. M. Kelm: Research Support; Self; Abbott, B. Braun Medical Inc., Philips. Other Relationship; Self; Amgen, Ancora Heart, Dai-ichi Life Insurance Company. M. Roden: Advisory Panel; Self; Servier. Board Member; Self; Poxel SA. Consultant; Self; Eli Lilly and Company, Gilead Sciences, Inc., ProSciento, TARGET PharmaSolutions. Research Support; Self; Boehringer Ingelheim International GmbH, Novartis Pharma K.K., Sanofi US. Speaker’s Bureau; Self; Novo Nordisk A/S. J. Szendroedi: None.