422-P: Association between Nonalcoholic Fatty Liver Disease and Diastolic Myocardial Dysfunction and Myocardial Insulin Resistance in Patients with Type 2 Diabetes

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes and associated with cardiovascular risks. We investigated whether degree of NAFLD was associated with myocardial dysfunction in relation to myocardial glucose uptake in patients with type 2 diabetes. A total of 131 patients with type 2 diabetes were included from a tertiary care hospital. Myocardial glucose uptake was assessed using [18F]-FDG-PET scan. Hepatic steatosis and fibrosis were determined using transient liver elastography (Fibroscan). Echocardiogram was performed to evaluate cardiac structure and function. Patients with NAFLD revealed cardiac diastolic dysfunction with increased left ventricular filling pressure (E/e’ ratio) and left atrial volume index (LAVI) compared with patients without NAFLD (all p<0.05). Hepatic steatosis was correlated with E/e’ ratio and LAVI, and hepatic fibrosis was also correlated with E/e’ ratio (all p < 0.05). In linear regression analyses, degree of hepatic steatosis and fibrosis were independent determinant factors for a higher E/e’ ratio even after adjusting for confounding factors (r²=0.409, p=0.041 for steatosis and r²=0.423, p=0.009 for fibrosis). Higher degree of steatosis and fibrosis were associated with decreased myocardial glucose uptake (p for trends=0.084 and 0.012 for steatosis and fibrosis, respectively). Furthermore, decreased myocardial glucose uptake was an independent determinant factor for a higher E/e’ ratio (r²=0.409, p=0.04).

In conclusion, hepatic steatosis and fibrosis are significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with decreased myocardial glucose uptake.